Abnormal Urinalysis - Haematuria, Nephrotic, Renal Stones, Lower UTI Flashcards
(37 cards)
What are the causes of transient or spurious non-visible haematuria?
- Urinary tract infection (UTI)
- Menstruation
- Vigorous exercise (usually settles after ~3 days)
- Sexual intercourse
List the causes of persistent non-visible haematuria.
Cancer (bladder, renal, prostate)
Stones
Benign prostatic hyperplasia (BPH)
Prostatitis
Urethritis (e.g., Chlamydia)
Renal causes: IgA nephropathy, thin basement membrane disease
What are spurious causes of red/orange urine where blood is not present on dipstick?
Foods: Beetroot, Rhubarb
Drugs: Rifampicin, Doxorubicin
Should screening for haematuria be routinely performed?
Current evidence does not support routine screening for haematuria.
How is persistent non-visible haematuria defined?
Blood being present in 2 out of 3 urine samples tested 2-3 weeks apart.
What additional tests should be performed when investigating non-visible haematuria?
Renal function tests
Albumin ratio (ACR) or protein ratio (PCR)
Blood pressure measurement
What does NICE 2015 urgent cancer referral guideline suggest for patients aged ≥45 years with visible haematuria?
Urgent referral (within 2 weeks) if:
Unexplained without UTI, OR
Persists/recurs after successful UTI treatment
When should patients aged ≥60 years be referred urgently under NICE guidelines?
Unexplained non-visible haematuria with either:
- dysuria
- or a raised white cell count on a blood test.
What does the NICE guideline suggest for non-urgent referral in patients aged ≥60 years?
Persistent unexplained UTI
According to guidelines, do patients under 40 years with normal renal function, no proteinuria, and normotensive require referral?
No, they do not need referral and may be managed in primary care.
What are the three main features of nephrotic syndrome?
Proteinuria (> 3g/24hr)
Hypoalbuminaemia (< 30g/L)
Oedema
What are the primary causes of nephrotic syndrome?
Minimal change disease
Focal segmental glomerulosclerosis (FSGS)
Membranous nephropathy
What are some secondary causes of nephrotic syndrome?
Diabetes mellitus
Systemic lupus erythematosus (SLE)
Amyloidosis
Infections (HIV, hepatitis B and C)
Drugs (NSAIDs, gold therapy)
Describe the pathophysiology of nephrotic syndrome.
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.
How does nephrotic syndrome increase the risk of thrombosis?
Loss of antithrombin-III, proteins C and S
Associated rise in fibrinogen levels
What effect does nephrotic syndrome have on thyroxine levels?
Loss of thyroxine-binding globulin = lowers total thyroxine levels,
but free thyroxine levels remain unaffected.
What is the first step in investigating suspected nephrotic syndrome?
Perform a urine dipstick test to check for proteinuria and microscopic haematuria.
Why is it important to perform a midstream urine (MSU) test in nephrotic syndrome?
To exclude urinary tract infection (UTI).
How is proteinuria quantified in the initial investigation of nephrotic syndrome?
Using an early morning urinary protein
ratio (PCR) or albumin
ratio (ACR).
What blood tests should be included in the initial investigation of nephrotic syndrome?
Full blood count (FBC)
Coagulation screen
Urea and electrolytes
List the 5 initial investigations you would request for suspected Nephrotic Syndrome
Urine dipstick
MSU
Early morning urinary protein:creatinine ratio or albumin:creatinine ratio.
FBC and coagulation screen
Urea and electrolytes
What is the radiograph appearance of calcium oxalate renal stones, and how frequent are they?
Radiograph appearance: Opaque
Frequency: 40%
What is the radiograph appearance of mixed calcium oxalate/phosphate stones, and how frequent are they?
Radiograph appearance: Opaque
Frequency: 25%
What is the radiograph appearance of triple phosphate stones (struvite), and how frequent are they?
Radiograph appearance: Opaque
Frequency: 10%
