eval of hematuria

Question 1

how does the AUA classify hematuria

Answer 1

greater than 3 RBCs per high power field in 2-3 properly collected urine on two seperate urinalysis over a 2 week period

Question 2

does the degree of hematuria correspond with the seriousness of the underlying condition

Answer 2

NO

Question 3

should pts on coumadin have hematuria

Answer 3

NO; if there INR is off they might but they shouldn’t spontaneously bleed one day

Question 4

Glomerular hematuria (color, clots, proetinuria, RBC morhphology, and RBC casts)

Answer 4

color: red, smoky brown, cola-colored
clots: absent
preoteinuria: sometimes; may be >500mg/day
RBC morph: dysmorphic
RBC casts: likely present

Question 5

Extraglomerular (color, clots, proetinuria, RBC morhphology, and RBC casts)

Answer 5

color: red or pink
clots: may be present
preoteinuria: <500mg/day
RBC morph: normal
RBC casts: absent

Question 6

causes of glomerular hematuria

Answer 6

glomerulonephritis
vasculitis
IgA nephropathy
thin basement membrane (congenital)
hereditary nephritis
chronic interstitial nephritis

Question 7

extraglomerular hematuria causes

Answer 7

renal parenchyma
ureters, 
bladder
prostate, urethra
systemic illness
infections
nephrolithiasis
calculus
malignancy
cystic disease
vascular disorder

Question 8

historical clues for extraglomerular hematuria

Answer 8

dysuria, pyuria, fevers (UTI, pyelonephritis, prostatitis, urethritis, malignancy)
urethral discharge (urethritis, prostatitis)
flank pain (pyelonephritis, stones, neoplasm, ischemia, GN)
hesitancy, dribbling (BPH)
recent strenuous exercise (trauma)
menstrual hx (cyclic hematuria from endometriosis of urinary tract)

Question 9

historical clues for glomerular hematuria

Answer 9

gross, painless hematuria (bladder CA, post-infectious GN, CA)
fevers, rash, arthralgias (GN assoc with vasculitis)
recent URI (post-infectious GN)
fhx of renal disease( ADPKS, alport’s disease, thin basement membrane, sickle cell disease)
detailed medication review (NSAIDs, abx, anticoags)

Question 10

physical exam clues for extraglomerular hematuria

Answer 10

suprapubic tenderness (UTI)
CVA tenderness (pyelonephritis)
urethral discharge (urethritis)
enlarged prostate (BPH, prostatitis, nodular)

Question 11

physical exam clues for glomerular hematuria

Answer 11

skin lesions (coagulopathy, vasculitis, SLE)
hypertension, periorbital edema, generalized edema

Question 12

initial labs to order with hematuria

Answer 12

urinalysis with microscopy
urine cytology
CBC with diff
serum creatinine
BUN
urine culture