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National Kidney Foundation's Primer on Kidney Diseases > Chapter 5: Hematuria and Proteinuria > Flashcards

Chapter 5: Hematuria and Proteinuria Flashcards

1
Q

definition of hematuria

A

presence of erythrocytes in urine

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2
Q

2 types of hematuria

A
  1. macroscopic = grossly visible

2. microscopic = only detectable on urine dipstick

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3
Q

if urine is negative for heme, what are some rare causes of discoloration?

A
  • porphyria
  • beetroot ingestion
  • drugs such as rifampin
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4
Q

what are some causes of increased erythrocytes in urine?

A
  • strenuous exertion
  • menstruation
  • urethral catheterization
  • bladder trauma
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5
Q

definition of microscopic hematuria

A

2 or more erythrocytes per HPF on light microscopy in centrifuged sediment

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6
Q

causes of hematuria:

hematuria confirmed? if NO

A

other causes: drugs, pigments, hemaglobinuria, myoglobinuria

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7
Q

causes of hematuria:

hematuria confirmed? if YES, what’s the next question to ask?

A

intermittent or sustained?

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8
Q

causes of hematuria:

if intermittent, what are some possible causes?

A
  • infection
  • “jogger’s nephritis”
  • menstruation
  • catheter associated
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9
Q

causes of hematuria:

if sustained, what’s the next question to ask?

A

macroscopic or microscopic?

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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?

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11
Q

causes of hematuria:

if macroscopic hematuria is is throughout stream, then source is?

A

kidney origin

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12
Q

causes of hematuria:

if macroscopic hematuria is early in stream, then source is?

A

urethral origin

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13
Q

causes of hematuria:

if macroscopic hematuria is late in stream, then source is?

A

bladder or prostate origin

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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?

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15
Q

causes of hematuria:

if microscopic, and there are NO casts, and NO proteinuria

A
  • thin membrane disease

- Alport syndrome

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16
Q

causes of hematuria:

if microscopic, and there are casts, and proteinuria

A

glomerulonephritis

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17
Q

what are some risk factors for urologic malignancy? (8)

A
  1. age > 40 years
  2. smoking history
  3. occupational exposure to benzene or amine dyes
  4. h/o gross hematuria
  5. h/o chronic cystitis
  6. h/o pelvic irradiation
  7. h/o cyclophosphamide use
  8. h/o analgesic abuse
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18
Q

macroscopic hematuria of glomerular origin occurs in what 3 conditions?

A
  • IgA nephropathy
  • renal vasculitis
  • complication of AC
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19
Q

macroscopic hematuria can also occur 2/2 what?

A
  • renal tubular damage

- AKI

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20
Q

persistent, isolated hematuria of glomerular origin is important bc it indicates an increased risk of?

A

ESRD

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21
Q

what are the 4 main causes of persistent, isolated hematuria of glomerular origin associated with ESRD?

A
  1. IgA nephropathy
  2. Alport syndrome
  3. mesangioproliferative glomerulonephritis w/o IgA deposits
  4. thin basement membrane disease
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22
Q

rare causes of hematuria

A
  • hereditary hemorrhagic telangiectasia
  • schistosomiasis
  • radiation cystitis
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23
Q
  • left renal vein compressed between aorta and proximal superior mesenteric artery
  • left flank pain
  • orthostatic proteinuria
  • hematuria
A

nutcracker syndrome

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24
Q
  • dysmorphic RBCs
  • loin pain (can be severe)
  • usually normal kidney function
A

loin pain hematuria syndrome

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25
Q

findings on UA in favor of glomerular bleeding diagnosis

A
  • RBC casts
  • proteinuria > 500 mg/day
  • dysmorphic RBCs
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26
Q

investigation of hematuria:

hematuria suspected, next step?

A

urine dipstick

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27
Q

investigation of hematuria:

pus cells seen on urine dipstick, next step?

A

urine culture

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28
Q

investigation of hematuria:

if hematuria identified on urine dipstick, next step?

A

urine microscopy

29
Q

investigation of hematuria:

if hematuria identified on urine microscopy: NO casts present, next step?

A

urine cytology

30
Q

investigation of hematuria:

if hematuria identified on urine microscopy: NO casts present, next step after urine cytology

A

US and/or CT scan

31
Q

investigation of hematuria:

if hematuria identified on urine microscopy: NO casts present, next step after urine cytology, US and/or CT scan

A

consider angiography or cystoscopy

32
Q

investigation of hematuria:

if hematuria identified on urine microscopy: RBC casts, waxy casts, dysmorphic RBCs, next step?

A
  • quantitate proteinuria
  • blood tests including eGFR
  • immunology screen
33
Q

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?

A

kidney US and then kidney biopsy

34
Q

in groups what are the causes of hematuria?

A
  • glomerular hematuria
  • nonglomerular hematuria
  • other
35
Q

causes of glomerular hematuria: primary glomerulonephritis (8)

A
  • membranoproliferative glomerulonephritis
  • mesangioproliferative glomerulonephritis
  • crescentic glomerulonephritis
  • anti-GBM disease
  • focal segmental glomerulosclerosis
  • membranous glomerulopathy
  • minimal change disease
  • fibrillary glomerulopathy
36
Q

causes of glomerular hematuria: multisystem or autoimmune d/o (4)

A
  • SLE
  • vasculitis
  • scleroderma glomerulopathy
  • thrombotic microangiopathy
37
Q

causes of glomerular hematuria: other (4)

A
  • Alport syndrome (hereditary)
  • Fabry disease (hereditary)
  • thin basement membrane disease (hereditary)
  • infection associated glomerulonephritis
38
Q

causes of nonglomerular hematuria: kidney origin

A
  • tubulointerstitial nephritis
  • hypersensitivity tubulointerstitial nephritis
  • TINU (tubulointerstitial nephritis and uveitis syndrome)
  • Sjogren syndrome
  • vascular d/o
  • papillary necrosis
  • malignancy
39
Q

causes of nonglomerular hematuria: kidney origin d/t vascular d/o’s (5)

A
  • malignant HTN
  • renal artery or vein thrombosis
  • AVM
  • scleroderma renal crisis
  • polyarteritis nodosa
40
Q

causes of nonglomerular hematuria: kidney origin d/t malignancy (4)

A
  • renal cell carcinoma
  • Wilms tumor
  • lymphoma/leukemia
    metastatic disease
41
Q

causes of nonglomerular hematuria: kidney origin d/t infection

A
  • pyelonephritis
  • tuberculosis
  • BK nephropathy
42
Q

hereditary causes of nonglomerular hematuria: kidney origin

A
  • polycystic kidney disease

- medullary sponge kidney

43
Q

other causes of nonglomerular hematuria: kidney origin

A
  • trauma

- idiopathic hematuria

44
Q

causes of nonglomerular hematuria: urinary tract origin

A
  • malignancy
  • vascular
  • infection
  • calculi
  • inflammatory
  • vasculitis
  • drugs (cyclophosphamide)
  • trauma/foreign body
45
Q

causes of nonglomerular hematuria: urinary tract origin d/t malignancy

A
  • transitional cell carcinoma

- carcinoma of the bladder/prostate

46
Q

vascular causes of nonglomerular hematuria: urinary tract origin

A

malformations/nevi

47
Q

causes of nonglomerular hematuria: urinary tract origin d/t infection

A
  • cystitis
  • prostatitis
  • tuberculosis
  • schistomiasis
48
Q

inflammatory causes of nonglomerular hematuria: urinary tract origin

A
  • retroperitoneal fibrosis/aortitis
  • endometriosis
  • diverticulitis/Crohn’s disease
  • hypersensitivity cystitis
49
Q

causes of nonglomerular hematuria: urinary tract origin d/t vasculitis

A
  • Churg-Strauss angiitis

- polyarteritis nodosa

50
Q

other causes of nonglomerular hematuria: urinary tract origin

A
  • loin pain hematuria syndrome
  • acquired cystic disease of kidney failure
  • coagulation d/o
  • factitious
51
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

MPGN

A
  • C3/C4
  • C3 nephritic factor
  • cyroglobulins
  • hepatitis B and C
52
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

anti-GBM disease

A
  • anti-GBM antibodies

- CXR

53
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

fibrillary and immunotactoid glomerulopathy

A
  • serum and urine electrophoresis
  • C3/C4
  • calcium
  • bone marrow bx
  • skeletal survey
54
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

SLE

A
  • ANA
  • anti-dsDNA
  • ENAs
  • C3/C4
  • anticardiolipin Ab
55
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

vasculitis (granulomatosis w/ polyangitis, microscopic polyangiitis, Churg-Strauss angiitis)

A
  • 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
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

thrombotic microangiopathy

A
  • anticardiolipin Ab

- lupus anticoagulant

57
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

Alport disease

A

audiometry

58
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

Fabry disease

A

plasma a-galactosidase A activity

59
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

HIV nephropathy

A

HIV

60
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

poststreptococcal glomerulonephritis

A
  • ASO
  • anti-DNAase
  • C3/C4
  • rheumatoid factor
61
Q

laboratory investigation of glomerular hematuria: relevant abnormal investigations

infective endocarditis

A
  • echocardiography
  • C3/C4
  • rheumatoid factor
62
Q

glomerular hematuria initial screening:

  • RBC casts
  • RPGN
  • lung hemorrhage

next step

A

anti-GBM Abs

63
Q

glomerular hematuria initial screening:

if anti-GBM Abs positive

A

Goodpasture disease

64
Q

glomerular hematuria initial screening:

  • if ANA POSITIVE
  • if anti-ds-DNA positive
A

SLE

65
Q

glomerular hematuria initial screening:

  • if ANA POSITIVE
  • if anti-cardiolipin Ab or lupus anticoagulant positive
A

antipospholipid syndrome

66
Q

glomerular hematuria initial screening:

  • if ANA POSITIVE
  • anti-SCL70 or anti-RNA polymerase III positive
A

scleroderma

67
Q

glomerular hematuria initial screening:

  • if ANA POSITIVE
  • anti-Ro/La positive
A

Sjogren syndrome

68
Q

glomerular hematuria initial screening:

  • if ANCA POSITIVE
  • if anti-MPO positive
A

microscopic polyangiitis

69
Q

glomerular hematuria initial screening:

  • if ANCA POSITIVE
  • if anti-PR3 positive
A

granulomatosis w/ polyangiitis

National Kidney Foundation's Primer on Kidney Diseases (2 decks)

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