B/11. Hematuria Flashcards
Microscopic
hematuria detected by
Detected by urine dipstick
or
urine microscopy (>3-5 RBC per HPF)
Microscopic
hematuria suggests
Most commonly suggests intrinsic renal disease
(glomerular hematuria)
Macroscopic
hematuria def
Red or brown urine visible by
naked eyes
Macroscopic
hematuria source
Most commonly suggests
postrenal source in the
urinary collecting system (non-glomerular hematuria)
is red urine equal to hematuria?
NO
neg dipstick, neg urine sediment
= mimics of hematuria (drugs, food)
+dipstick, -urine sediment =
myoglobinuria (rhabodmyolysis), hemoglobinuria (hemolysis)
+dipstick, + urine sediment =
true hematuria (see DDx
Urine dipstick indicates hematuria based on
peroxidase activity;
yields positive results with both hemoglobin
and myoglobin.
Positive result must be followed up by urinalysis.
postive result of urine dipstick must be followed up by
urinalysis
Glomerular hematuria etiology
- Nephritic syndrome
- Isolated hematuria:
*transient (strenuous exercise, infections),
*persistent (IgA nephropathy, Alport syndrome,
thin basement membrane nephropathy)
transient Isolated hematuria etiologies
(strenuous
exercise, infections)
persistent Isolated hematuria etiologie
- IgA nephropathy
- Alport syndrome
- thin basement membrane
nephropathy
Nonglomerula hematuria etiologies
- 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
drugs causing non glomeruar hematuria/macroscopic
Drugs:
cyclophosphamide,
sulfonamides,
warfarin,
heparin
Malignancy causing macroscopic hematuria
(especially in otherwise asymptomatic):
* urothelial cancer
* renal cell cancer
* prostate cancer
* nephroblastoma
Initial evaluation of hematuria
- 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
diagnosis of hematuria
- 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
Hematuria
Pyuria
+/- bacteriuria
+/- fever and systemic signs
suspicious for ?
what to proceed with?
*Upper UTI or
*complicated lower UTI
- Urine culture
- +/- blood culture
- +/- imaging
- Empiric AB
Young female with dysuria, urgency,
frequency, hematuria, and suprapubic pain
- Non-complicated UTI (cystitis or urethritis)
Empiric AB
Isolated painless hematuria with nondysmorphic
RBC, male patient > 35 years,
smoking history
Urinary tract
neoplasm
- Imaging (cystoscopy, US, CT)
- Urine cytology
Isolated painless hematuria in a child
Congenital
anomaly
* imaging
Hematuria presenting with acute-onset
unilateral flank pain
Urolithiasis
- Imaging (US or low-dose CT)
- Check serum Ca2+ or UA levels
Hematuria with dysmorphic RBC,
proteinuria, RBC casts
Glomerulonephritis
- Autoimmune panel
- Infectious disease panel
- Complement levels
- Hematologic evaluation
- Renal biopsy (definitive diagnosis
