Blood in urine: Microscopic and macroscopic haematuria Flashcards
How is haematuria termed? 2
Non-glomerular
Glomerular
What are the chemicals and changes that happen when urine dipstick is used to test for blood? Positve colour?
tetramethylbenzidine reacts with heme to produce oxidised chromogen
Green-blue
Risk factors for kidney or urinary tract cancer
- Age
- Smoking
- Exposures to benzene, aromatic amines (dyes, road fumes), carcinogens, chemotherapy (eg: cyclophosphamide), or high doses of analgesics
- A history of:
- Irritative voiding symptoms
- Chronic urinary tract infection
- Indwelling urinary catheter
- Pelvic irradiation (radiotherapy)
Risk factors for kidney or urinary tract cancer
- Age
- Smoking
- Exposures to benzene, aromatic amines (dyes, road fumes), carcinogens, chemotherapy (eg: cyclophosphamide), or high doses of analgesics
- A history of:
- Irritative voiding symptoms
- Chronic urinary tract infection
- Indwelling urinary catheter
- Pelvic irradiation (radiotherapy)
What do muddy-brown casts in urine microscopy mean?
substance that has been stuck in the kidney tubules and then later flushed out in urine= kindney loss of functio
What is creatine kinase a marker for
Muscle damage inflammation
What is a good marker for Muscle damage inflammation
creatine kinase
What is rhabdomyolysis?
the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood
Risk factors for rhabdomyolysis
extreme exercise, crush injury, STATINS
What is treatment for rhabdomyolysis
promote diuresis with hydration, support for AKI (ie: dialysis)
What does blood urine look like for renal cancer ?
Bright red
How does rhabdomyolysis cause positive blood in urine
releases (among other things) myoglobin.
Normally bound to plasma protein – once binding capacity exceeded,
filtered at glomerulus, causes tubular obstruction, and myoglobinuria
(myoglobin contains heme subunit so reacts positively to dipstick
reagent)
How does Henoch-Schonlein purpura (HSP) present
Presents with haematuria (visible or non-visible,
glomerular haematuria), palpable purpuric rash
What is the diagnosis?
haematuria (visible or non-visible,
glomerular haematuria), palpable purpuric rash
Henoch-Schonlein purpura (HSP)
What causes the signs of Henoch-Schonlein purpura (HSP)
Caused by IgA deposits in vessels (kidney, skin), so
the glomerular component of HSP is IgA nephropathy.
What is the most common types of glomerulonephritis
IgA nephropathy
What happns if someone is older than 35 and has haematuria?
Fulll tract incvestigation of cancer
What typically presents as sudden onset left loin pain, radiating to her groin
Kidney stone
What are risks of kidney stones?
— metabolic syndrome, heat (concentrated urine), thiazide
diuretics (increase calciuria)
What is ANCA vasculitis?
Systemic disease caused by circulating antibody –Antineutrophil cytoplasmic antibody (ANCA)
What does ANCA vasculitis cause?
systemic vasculitis and granulomatosis of multiple target
organs. Classically causes pulmonary-renal syndrome with rapidly
progressive kidney injury and lung injury
What is the treatment for ANCA vasculitis?
immunosuppression (steroids/cyclophosphamide
or rituximab)
How does ANCA vasculitis present
ANCA antibody positive Dramatic fall in kidney function
raised creatinine /urea)
vascular tunic looking rash
eyes look very inflamed and red
How does ANCA vasculitis present on a biopsy?
Focal segmental necrotising GN with crescent formation
What confirms a positve non-visible haematuria
NVH = either 2 positive urine dipsticks (out of 3 tests) OR >3 RBCs/HPF by microscopy
What happens if there is it si not positive for blood in a red urine?
Look out for high protein -IgA nephropathy