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Urology > B/11. Hematuria > Flashcards

B/11. Hematuria Flashcards

1
Q

Microscopic
hematuria detected by

A

Detected by urine dipstick
or
urine microscopy (>3-5 RBC per HPF)

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2
Q

Microscopic
hematuria suggests

A

Most commonly suggests intrinsic renal disease
(glomerular hematuria)

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3
Q

Macroscopic
hematuria def

A

Red or brown urine visible by
naked eyes

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4
Q

Macroscopic
hematuria source

A

Most commonly suggests
postrenal source in the
urinary collecting system (non-glomerular hematuria)

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5
Q

is red urine equal to hematuria?

A

NO

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6
Q

neg dipstick, neg urine sediment

A

= mimics of hematuria (drugs, food)

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7
Q

+dipstick, -urine sediment =

A

myoglobinuria (rhabodmyolysis), hemoglobinuria (hemolysis)

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8
Q

+dipstick, + urine sediment =

A

true hematuria (see DDx

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9
Q

Urine dipstick indicates hematuria based on

A

peroxidase activity;

yields positive results with both hemoglobin
and myoglobin.
Positive result must be followed up by urinalysis.

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10
Q

postive result of urine dipstick must be followed up by

A

urinalysis

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11
Q

Glomerular hematuria etiology

A
  • Nephritic syndrome
  • Isolated hematuria:
    *transient (strenuous exercise, infections),
    *persistent (IgA nephropathy, Alport syndrome,
    thin basement membrane nephropathy)
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12
Q

transient Isolated hematuria etiologies

A

(strenuous
exercise, infections)

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13
Q

persistent Isolated hematuria etiologie

A
  • IgA nephropathy
  • Alport syndrome
  • thin basement membrane
    nephropathy
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14
Q

Nonglomerula hematuria etiologies

A
  • Urolithiasis
  • Infection: cystitis, urethritis, prostatitis
  • Malignancy (especially in otherwise asymptomatic): urothelial cancer, renal cell cancer, prostate cancer, nephroblastoma
  • Coagulation disorders: PLT dysfunction, hemophilia
  • Urinary tract obstruction: BPH, congenital anomalies
  • PCKD
  • Renal papillary necrosis: sickle cell disease, acute pyelonephritis, DM, analgesics
  • Trauma: to the urethra, bladder, ureter, kidney
  • Drugs: cyclophosphamide, sulfonamides, warfarin, heparin
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15
Q

drugs causing non glomeruar hematuria/macroscopic

A

Drugs:
cyclophosphamide,
sulfonamides,
warfarin,
heparin

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16
Q

Malignancy causing macroscopic hematuria

A

(especially in otherwise asymptomatic):
* urothelial cancer
* renal cell cancer
* prostate cancer
* nephroblastoma

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17
Q

Initial evaluation of hematuria

A
  • first step in the evaluation of patients with a positive dipstick for heme or with red or brown urine is
  • to confirm the presence of hematuria by microscopic analysis of a fresh, centrifuged specimen
18
Q

diagnosis of hematuria

A
  • History: smoking, renal disease in family, sickle cell disease in family, drugs (nephrotoxic,
    anticoagulants), travel history to areas endemic to Schistosoma haematobium and TB
  • Physical examination: urinary symptoms and systemic approach
    Complete urinalysis
  • Urine culture (if infectious etiology suspected)
  • Urine cytology (if urinary tract neoplasm suspected)
  • Imaging: US, low-dose CT, cystoscopy, IV pyelography
19
Q

Hematuria
Pyuria
+/- bacteriuria
+/- fever and systemic signs
suspicious for ?
what to proceed with?

A

*Upper UTI or
*complicated lower UTI

  • Urine culture
  • +/- blood culture
  • +/- imaging
  • Empiric AB
20
Q

Young female with dysuria, urgency,
frequency, hematuria, and suprapubic pain

A
  • Non-complicated UTI (cystitis or urethritis)
    Empiric AB
21
Q

Isolated painless hematuria with nondysmorphic
RBC, male patient > 35 years,
smoking history

A

Urinary tract
neoplasm
- Imaging (cystoscopy, US, CT)
- Urine cytology

22
Q

Isolated painless hematuria in a child

A

Congenital
anomaly
* imaging

23
Q

Hematuria presenting with acute-onset
unilateral flank pain

A

Urolithiasis

  • Imaging (US or low-dose CT)
  • Check serum Ca2+ or UA levels
24
Q

Hematuria with dysmorphic RBC,
proteinuria, RBC casts

A

Glomerulonephritis
- Autoimmune panel
- Infectious disease panel
- Complement levels
- Hematologic evaluation
- Renal biopsy (definitive diagnosis

25
Q

Women presenting with hematuria shortly
after (or during) menses

A

Repeat urinalysis later in the cycle (once menstrual bleeding
has ceased

26
Q

Patient presenting with hematuria shortly
after vigorous exercise

A

Repeat confirmatory urinalysis within 4-6 weeks

27
Q

Patient presenting with hematuria after
acute trauma

A
  • Exclude active bleeding (imaging)
  • Repeat confirmatory urinalysis within 4-6 weeks
28
Q

Patient presenting with hematuria, anuria,
N/V, confusion, edema, dyspnea

A

AKI
- Rule-out pre-renal causes: check urine osmol, FeNa, BUN/Cr
- Rule-out post-renal causes: imaging with US and/or CT
- Rule-out intrinsic-renal causes Biopsy if all above are negative

29
Q
  • Rule-out pre-renal causes of hematuria
A

check urine osmol, FeNa, BUN/Cr

values for pre-renal hematuria:

urine osmol >500

FeNa < 1

BUN/Cr >20

30
Q
  • Rule-out post-renal causes of hematuria
A

imaging with US and/or CT

31
Q
  • Rule-out intrinsic-renal causes of hematuria
A
  • Biopsy if all above (urine osmol, FeNa, BUN/Cr, imaging US/CT) are negative
32
Q

Presence of casts in urine indicates that

A

hematuria/pyuria is of glomerular or renal tubular origin

33
Q

hematuria with no casts is typical for

A

kidney stones
bladder cancer

34
Q

pyuria, no casts is typical for

A

acute cystitis

35
Q

causes of RBC casts

A

Glomerulonephritis,
HTN emergency

36
Q

WBC casts

A
  • Tubulointerstitial inflammation,
  • acute pyelonephritis,
  • transplant rejection
37
Q

Granular casts

A

ATN ( can be muddy brown in appearance)

38
Q

Fatty casts ( oval fat bodies)

A

Nephrotic syndrome ( associated with maltese cross sign)

39
Q

Waxy casts

A

End stage renal disease/ CKD

40
Q

Hyaline casts

A
  • Nonspecific, can be a normal finding.
  • Form via solidification of Tamm-Horsdall
    mucoprotein (secreted by renal tubular cells)

Urology (30 decks)

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