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Acute and Emergency - Presentations > Abnormal Urinalysis - Haematuria, Nephrotic, Renal Stones, Lower UTI > Flashcards

Abnormal Urinalysis - Haematuria, Nephrotic, Renal Stones, Lower UTI Flashcards

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1
Q

What are the causes of transient or spurious non-visible haematuria?

A
  • Urinary tract infection (UTI)
  • Menstruation
  • Vigorous exercise (usually settles after ~3 days)
  • Sexual intercourse
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2
Q

List the causes of persistent non-visible haematuria.

A

Cancer (bladder, renal, prostate)
Stones
Benign prostatic hyperplasia (BPH)
Prostatitis
Urethritis (e.g., Chlamydia)
Renal causes: IgA nephropathy, thin basement membrane disease

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3
Q

What are spurious causes of red/orange urine where blood is not present on dipstick?

A

Foods: Beetroot, Rhubarb
Drugs: Rifampicin, Doxorubicin

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4
Q

Should screening for haematuria be routinely performed?

A

Current evidence does not support routine screening for haematuria.

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5
Q

How is persistent non-visible haematuria defined?

A

Blood being present in 2 out of 3 urine samples tested 2-3 weeks apart.

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6
Q

What additional tests should be performed when investigating non-visible haematuria?

A

Renal function tests
Albumin ratio (ACR) or protein ratio (PCR)
Blood pressure measurement

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7
Q

What does NICE 2015 urgent cancer referral guideline suggest for patients aged ≥45 years with visible haematuria?

A

Urgent referral (within 2 weeks) if:

Unexplained without UTI, OR
Persists/recurs after successful UTI treatment

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8
Q

When should patients aged ≥60 years be referred urgently under NICE guidelines?

A

Unexplained non-visible haematuria with either:
- dysuria
- or a raised white cell count on a blood test.

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9
Q

What does the NICE guideline suggest for non-urgent referral in patients aged ≥60 years?

A

Persistent unexplained UTI

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10
Q

According to guidelines, do patients under 40 years with normal renal function, no proteinuria, and normotensive require referral?

A

No, they do not need referral and may be managed in primary care.

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11
Q

What are the three main features of nephrotic syndrome?

A

Proteinuria (> 3g/24hr)
Hypoalbuminaemia (< 30g/L)
Oedema

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12
Q

What are the primary causes of nephrotic syndrome?

A

Minimal change disease
Focal segmental glomerulosclerosis (FSGS)
Membranous nephropathy

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13
Q

What are some secondary causes of nephrotic syndrome?

A

Diabetes mellitus
Systemic lupus erythematosus (SLE)
Amyloidosis
Infections (HIV, hepatitis B and C)
Drugs (NSAIDs, gold therapy)

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14
Q

Describe the pathophysiology of nephrotic syndrome.

A

Damage to the glomerular basement membrane and podocytes increases permeability to proteins, leading to proteinuria.
This proteinuria causes hypoalbuminaemia, reducing plasma oncotic pressure and resulting in oedema.

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15
Q

How does nephrotic syndrome increase the risk of thrombosis?

A

Loss of antithrombin-III, proteins C and S
Associated rise in fibrinogen levels

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16
Q

What effect does nephrotic syndrome have on thyroxine levels?

A

Loss of thyroxine-binding globulin = lowers total thyroxine levels,
but free thyroxine levels remain unaffected.

17
Q

What is the first step in investigating suspected nephrotic syndrome?

A

Perform a urine dipstick test to check for proteinuria and microscopic haematuria.

18
Q

Why is it important to perform a midstream urine (MSU) test in nephrotic syndrome?

A

To exclude urinary tract infection (UTI).

19
Q

How is proteinuria quantified in the initial investigation of nephrotic syndrome?

A

Using an early morning urinary protein
ratio (PCR) or albumin
ratio (ACR).

20
Q

What blood tests should be included in the initial investigation of nephrotic syndrome?

A

Full blood count (FBC)
Coagulation screen
Urea and electrolytes

21
Q

List the 5 initial investigations you would request for suspected Nephrotic Syndrome

A

Urine dipstick
MSU
Early morning urinary protein:creatinine ratio or albumin:creatinine ratio.
FBC and coagulation screen
Urea and electrolytes

22
Q

What is the radiograph appearance of calcium oxalate renal stones, and how frequent are they?

A

Radiograph appearance: Opaque
Frequency: 40%

23
Q

What is the radiograph appearance of mixed calcium oxalate/phosphate stones, and how frequent are they?

A

Radiograph appearance: Opaque
Frequency: 25%

24
Q

What is the radiograph appearance of triple phosphate stones (struvite), and how frequent are they?

A

Radiograph appearance: Opaque
Frequency: 10%

25
Q

What is the radiograph appearance of calcium phosphate renal stones?

A

opaque

26
Q

What is the radiograph appearance of cystine renal stones?

A

Semi-opaque, ‘ground-glass’ appearance

27
Q

What is the radiograph appearance of urate renal stones?

A

Radio-lucent

28
Q

**What are stag-horn calculi, and what are they composed of?

A

Stag-horn calculi involve the renal pelvis and extend into at least 2 calyces.
They develop in alkaline urine and are composed of struvite (ammonium magnesium phosphate, triple phosphate).

**Add image of radiograph of example

28
Q

What is the radiograph appearance of xanthine renal stones?

A

Radio-lucent

29
Q

Which infections predispose to the formation of stag-horn calculi?

A

Ureaplasma urealyticum
Proteus infections

30
Q

What are the clinical features of a lower urinary tract infection (UTI) in adults?

A

Dysuria
Urinary frequency
Urinary urgency
Cloudy/offensive-smelling urine
Lower abdominal pain
Low-grade fever
Malaise
Acute confusion (especially in elderly patients)

31
Q

In which group of women can a urine dipstick be used to aid in the diagnosis of a lower UTI?

A

Women < 65 years of age
No risk factors for complicated UTI

32
Q

What does a positive urine dipstick result for nitrite, leukocyte, and red blood cells indicate?

A

UTI is likely

33
Q

What does a urine dipstick result of negative for nitrite but positive for leukocyte indicate?

A

UTI is equally likely to other diagnoses

34
Q

What does a urine dipstick result that is negative for nitrite, leukocyte, and red blood cells suggest?

A

UTI is less likely

35
Q

In which patients should urine dipsticks NOT be used for diagnosing UTI?

A

Women > 65 years
Men
Catheterised patients

36
Q

When should a urine culture be sent in the investigation of a lower UTI?

A

Women aged > 65 years
Recurrent UTI (2 episodes in 6 months or 3 in 12 months)
Pregnant women
Men
Visible or non-visible haematuria

Acute and Emergency - Presentations (2 decks)

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