Haematuria Flashcards
Definition
Haematuria is the presence of blood in the urine
can vary from frank bleeding (macroscopic)
to the microscopic detection of red cells.
Probability diagnosis
Infection:
- cystitis (both sexes)/urethrotrigonitis (female)
- urethritis (male)
- prostatitis (male)
Calculi-kidney, ureteric, bladder
Bladder tumour
Common urological cancers that cause haematuria are;
bladder (70%)
kidney (17%)
kidney pelvis or ureter (7%)
prostate (5%).
Serious disorders not to be missed
Cardiovascular:
- kidney infarction
- kidney vein thrombosis
- prostatic varices
Neoplasia/cancer:
- kidney tumour
- urothelial: bladder, kidney, pelvis, ureter
- prostate cancer
Infection:
- infective endocarditis
- kidney tuberculosis
- acute glomerulonephritis
- blackwater fever (falciparum malaria)
IgA nephropathy
Kidney papillary necrosis
Other kidney disease
Pitfalls (often missed)
- Urethral prolapse/caruncle
- Pseudohaematuria (e.g. beetroot, porphyria)
- Benign prostatic hyperplasia
- Trauma: blunt or penetrating
- Foreign bodies
- Bleeding disorders
- Haemorrhagic cystitis
- Exercise (esp. long distance running)
- Radiation cystitis
- Menstrual contamination
- Rarities:
- hydronephrosis
- Henoch–Schönlein purpura
- schistosomiasis (bilharzia)
- polycystic kidneys
- kidney cysts
- endometriosis (bladder)
- systemic vasculitides
The commonest cause of glomerulonephritis leading to nephritic syndrome is?
IgA nephropathy.
nephritic syndrome = oedema + hypertension + haematuria
Masquerades checklist
Drugs (cytotoxics, anticoagulants) UTI
Is the patient trying to tell me something?
Consider artefactual haematuria.
Key history
Is it really haematuria?
Red discolouration can be due to haemolysis or red food dye.
The history should include
- nature of haematuria
- associations such as pain
- sexually transmitted infections
- dysuria and frequency.
- Drug history
- athletic history
- urological history
- sexual history
- recent trauma history
- travel history.
Key examination
General examination and vital signs, especially BP
CVS exam to exclude possible kidney embolisation
Abd exam especially for a palpable enlarged kidney or spleen
Suprapubic exam for bladder tenderness or enlargement
Rectal exam in men and vaginal examination in women
Investigations
All pts presenting with macroscopic haematuria or recurrent microscopic haematuria require both:
- radiological investigation of the upper urinary system and
- visualisation of the lower urinary system
to detect or exclude kidney pathology.
Consider it as carcinoma until proved otherwise.
Key investigations
Urine analysis
Urine MC
Urine cytology
FBE/ESR
Appropriate radiology e.g.
- intravenous urogram
- intravenous pyelogram
- ultrasound.
Direct imaging (e.g. cystoscopy)
Diagnostic tips
Macroscopic haematuria is always abnormal except in menstruating women.
Common sources of macroscopic haematuria are the bladder, urethra, prostate and kidney.
Joggers and athletes engaged in very vigorous exercise can develop transient microscopic haematuria.
The key radiological investigation is the intravenous urogram (pyelogram).
Sometimes blood in the urine can come from the rectum or vagina.
Painless frank haematuria is an ominous sign.
