Chapter 5: Hematuria and Proteinuria Flashcards
1
Q
definition of hematuria
A
presence of erythrocytes in urine
2
Q
2 types of hematuria
A
- macroscopic = grossly visible
2. microscopic = only detectable on urine dipstick
3
Q
if urine is negative for heme, what are some rare causes of discoloration?
A
- porphyria
- beetroot ingestion
- drugs such as rifampin
4
Q
what are some causes of increased erythrocytes in urine?
A
- strenuous exertion
- menstruation
- urethral catheterization
- bladder trauma
5
Q
definition of microscopic hematuria
A
2 or more erythrocytes per HPF on light microscopy in centrifuged sediment
6
Q
causes of hematuria:
hematuria confirmed? if NO
A
other causes: drugs, pigments, hemaglobinuria, myoglobinuria
7
Q
causes of hematuria:
hematuria confirmed? if YES, what’s the next question to ask?
A
intermittent or sustained?
8
Q
causes of hematuria:
if intermittent, what are some possible causes?
A
- infection
- “jogger’s nephritis”
- menstruation
- catheter associated
9
Q
causes of hematuria:
if sustained, what’s the next question to ask?
A
macroscopic or microscopic?
10
Q
causes of hematuria:
if macroscopic, what’s the next question to ask?
A
is it throughout stream, early in stream, or late in stream?
11
Q
causes of hematuria:
if macroscopic hematuria is is throughout stream, then source is?
A
kidney origin
12
Q
causes of hematuria:
if macroscopic hematuria is early in stream, then source is?
A
urethral origin
13
Q
causes of hematuria:
if macroscopic hematuria is late in stream, then source is?
A
bladder or prostate origin
14
Q
causes of hematuria:
if microscopic, what are the next 2 questions to ask?
A
does the urine microscopy have CASTS, and is there PROTEINURIA?
15
Q
causes of hematuria:
if microscopic, and there are NO casts, and NO proteinuria
A
- thin membrane disease
- Alport syndrome
16
Q
causes of hematuria:
if microscopic, and there are casts, and proteinuria
A
glomerulonephritis
17
Q
what are some risk factors for urologic malignancy? (8)
A
- age > 40 years
- smoking history
- occupational exposure to benzene or amine dyes
- h/o gross hematuria
- h/o chronic cystitis
- h/o pelvic irradiation
- h/o cyclophosphamide use
- h/o analgesic abuse
18
Q
macroscopic hematuria of glomerular origin occurs in what 3 conditions?
A
- IgA nephropathy
- renal vasculitis
- complication of AC
19
Q
macroscopic hematuria can also occur 2/2 what?
A
- renal tubular damage
- AKI
20
Q
persistent, isolated hematuria of glomerular origin is important bc it indicates an increased risk of?
A
ESRD
21
Q
what are the 4 main causes of persistent, isolated hematuria of glomerular origin associated with ESRD?
A
- IgA nephropathy
- Alport syndrome
- mesangioproliferative glomerulonephritis w/o IgA deposits
- thin basement membrane disease
22
Q
rare causes of hematuria
A
- hereditary hemorrhagic telangiectasia
- schistosomiasis
- radiation cystitis
23
Q
- left renal vein compressed between aorta and proximal superior mesenteric artery
- left flank pain
- orthostatic proteinuria
- hematuria
A
nutcracker syndrome
24
Q
- dysmorphic RBCs
- loin pain (can be severe)
- usually normal kidney function
A
loin pain hematuria syndrome
25
findings on UA in favor of glomerular bleeding diagnosis
- RBC casts
- proteinuria > 500 mg/day
- dysmorphic RBCs
26
investigation of hematuria:
hematuria suspected, next step?
urine dipstick
27
investigation of hematuria:
pus cells seen on urine dipstick, next step?
urine culture
28
investigation of hematuria:
if hematuria identified on urine dipstick, next step?
urine microscopy
29
investigation of hematuria:
if hematuria identified on urine microscopy: NO casts present, next step?
urine cytology
30
investigation of hematuria:
if hematuria identified on urine microscopy: NO casts present, next step after urine cytology
US and/or CT scan
31
investigation of hematuria:
if hematuria identified on urine microscopy: NO casts present, next step after urine cytology, US and/or CT scan
consider angiography or cystoscopy
32
investigation of hematuria:
if hematuria identified on urine microscopy: RBC casts, waxy casts, dysmorphic RBCs, next step?
- quantitate proteinuria
- blood tests including eGFR
- immunology screen
33
investigation of hematuria:
if hematuria identified on urine microscopy: RBC casts, waxy casts, dysmorphic RBCs, next step after quantitating proteinuria, blood tests including eGFR, and immunology screen?
kidney US and then kidney biopsy
34
in groups what are the causes of hematuria?
- glomerular hematuria
- nonglomerular hematuria
- other
35
causes of glomerular hematuria: primary glomerulonephritis (8)
- membranoproliferative glomerulonephritis
- mesangioproliferative glomerulonephritis
- crescentic glomerulonephritis
- anti-GBM disease
- focal segmental glomerulosclerosis
- membranous glomerulopathy
- minimal change disease
- fibrillary glomerulopathy
36
causes of glomerular hematuria: multisystem or autoimmune d/o (4)
- SLE
- vasculitis
- scleroderma glomerulopathy
- thrombotic microangiopathy
37
causes of glomerular hematuria: other (4)
- Alport syndrome (hereditary)
- Fabry disease (hereditary)
- thin basement membrane disease (hereditary)
- infection associated glomerulonephritis
38
causes of nonglomerular hematuria: kidney origin
- tubulointerstitial nephritis
- hypersensitivity tubulointerstitial nephritis
- TINU (tubulointerstitial nephritis and uveitis syndrome)
- Sjogren syndrome
- vascular d/o
- papillary necrosis
- malignancy
39
causes of nonglomerular hematuria: kidney origin d/t vascular d/o's (5)
- malignant HTN
- renal artery or vein thrombosis
- AVM
- scleroderma renal crisis
- polyarteritis nodosa
40
causes of nonglomerular hematuria: kidney origin d/t malignancy (4)
- renal cell carcinoma
- Wilms tumor
- lymphoma/leukemia
metastatic disease
41
causes of nonglomerular hematuria: kidney origin d/t infection
- pyelonephritis
- tuberculosis
- BK nephropathy
42
hereditary causes of nonglomerular hematuria: kidney origin
- polycystic kidney disease
| - medullary sponge kidney
43
other causes of nonglomerular hematuria: kidney origin
- trauma
| - idiopathic hematuria
44
causes of nonglomerular hematuria: urinary tract origin
- malignancy
- vascular
- infection
- calculi
- inflammatory
- vasculitis
- drugs (cyclophosphamide)
- trauma/foreign body
45
causes of nonglomerular hematuria: urinary tract origin d/t malignancy
- transitional cell carcinoma
| - carcinoma of the bladder/prostate
46
vascular causes of nonglomerular hematuria: urinary tract origin
malformations/nevi
47
causes of nonglomerular hematuria: urinary tract origin d/t infection
- cystitis
- prostatitis
- tuberculosis
- schistomiasis
48
inflammatory causes of nonglomerular hematuria: urinary tract origin
- retroperitoneal fibrosis/aortitis
- endometriosis
- diverticulitis/Crohn's disease
- hypersensitivity cystitis
49
causes of nonglomerular hematuria: urinary tract origin d/t vasculitis
- Churg-Strauss angiitis
| - polyarteritis nodosa
50
other causes of nonglomerular hematuria: urinary tract origin
- loin pain hematuria syndrome
- acquired cystic disease of kidney failure
- coagulation d/o
- factitious
51
laboratory investigation of glomerular hematuria: relevant abnormal investigations
MPGN
- C3/C4
- C3 nephritic factor
- cyroglobulins
- hepatitis B and C
52
laboratory investigation of glomerular hematuria: relevant abnormal investigations
anti-GBM disease
- anti-GBM antibodies
| - CXR
53
laboratory investigation of glomerular hematuria: relevant abnormal investigations
fibrillary and immunotactoid glomerulopathy
- serum and urine electrophoresis
- C3/C4
- calcium
- bone marrow bx
- skeletal survey
54
laboratory investigation of glomerular hematuria: relevant abnormal investigations
SLE
- ANA
- anti-dsDNA
- ENAs
- C3/C4
- anticardiolipin Ab
55
laboratory investigation of glomerular hematuria: relevant abnormal investigations
vasculitis (granulomatosis w/ polyangitis, microscopic polyangiitis, Churg-Strauss angiitis)
- c-ANCA also known as PR3-ANCA (for granulomatosis w/ polyangitis)
- p-ANCA also known as MPO-ANCA (for microscopic polyangiitis, Churg-Strauss angiitis)
56
laboratory investigation of glomerular hematuria: relevant abnormal investigations
thrombotic microangiopathy
- anticardiolipin Ab
| - lupus anticoagulant
57
laboratory investigation of glomerular hematuria: relevant abnormal investigations
Alport disease
audiometry
58
laboratory investigation of glomerular hematuria: relevant abnormal investigations
Fabry disease
plasma a-galactosidase A activity
59
laboratory investigation of glomerular hematuria: relevant abnormal investigations
HIV nephropathy
HIV
60
laboratory investigation of glomerular hematuria: relevant abnormal investigations
poststreptococcal glomerulonephritis
- ASO
- anti-DNAase
- C3/C4
- rheumatoid factor
61
laboratory investigation of glomerular hematuria: relevant abnormal investigations
infective endocarditis
- echocardiography
- C3/C4
- rheumatoid factor
62
glomerular hematuria initial screening:
- RBC casts
- RPGN
- lung hemorrhage
next step
anti-GBM Abs
63
glomerular hematuria initial screening:
if anti-GBM Abs positive
Goodpasture disease
64
glomerular hematuria initial screening:
- if ANA POSITIVE
- if anti-ds-DNA positive
SLE
65
glomerular hematuria initial screening:
- if ANA POSITIVE
- if anti-cardiolipin Ab or lupus anticoagulant positive
antipospholipid syndrome
66
glomerular hematuria initial screening:
- if ANA POSITIVE
- anti-SCL70 or anti-RNA polymerase III positive
scleroderma
67
glomerular hematuria initial screening:
- if ANA POSITIVE
- anti-Ro/La positive
Sjogren syndrome
68
glomerular hematuria initial screening:
- if ANCA POSITIVE
- if anti-MPO positive
microscopic polyangiitis
69
glomerular hematuria initial screening:
- if ANCA POSITIVE
- if anti-PR3 positive
granulomatosis w/ polyangiitis
