Haematuria Flashcards
What are the causes of haematuria
Glomerular:
- acute/chronic glomerulonephritis
- IgA nephropathy
- Henoch-schonlein purupura
- Familial nephritis e.g. Alport syndrome
- Thin basement membrane disease
Non-glomerular
- UTI
- trauma
- Renal stones and hypercalciuria
- Tumours
- Congenital anomalies
- Exercise
- Bleeding disorder, SCD
- Drugs
What questions should be asked for haematuria
Colour of urine
- Brown/cola-coloured: originating from the kidney
- Red/pink ± clots: bladder or urethra
Recent diet: beetroot and blackberries can turn the urine red
Frequency, dysuria: UTI
Abdominal pain/renal colic: clot, calculus or obstructive malformation
History of trauma to the loin/abdomen
History of recent viral infection (glomerulonephritis)
FHx bleeding disorder, HTN, kidney disease
What investigations should be done for haematuria
bedside: urine dip, urinalysis, urine MC&S, throat swab (?post-strep)
Bloods: ASO titres, FBC, Renal screen (U&Es, creatinine, Ca. phosphate, albumin), autoantibodies, complement levels, platelets, coag screen
Other: Kidney and urinary tract US, IV pyelogram, renal biopsy (Required if haematuria is persistent + proteinuria, HTN or impaired renal function)
What is Wilm’s tumour
Undifferentiated mesodermal tumour of intermediate cell mass – primitive renal tubules and mesenchymal cells
Most common intra-abdominal tumour of childhood (2nd most common cancer of childhood after ALL)
What are the features of Wilm’s tumour
<5yo (80%) – often 3yo
95% unilateral
1-2% familial /FHx
What are the risk factors for Wilm’s tumour
Children, <5yo
Beckwith-Wiedemann syndrome (specific body parts overgrow; usually presents at birth; islet cell hyperplasia)
WAGR syndrome (Wilm’s tumour, Aniridia, Genitourinary malformations, (mental) Retardation)
Hemihypertrophy
around 1/3 of cases are associated with a loss-of-function mutation in the WT1 gene on chromosome 11
What are the symptoms of Wilm’s tumour
Painless, enlarging abdominal mass
Painless Haematuria
Abdominal pain
Flank pain
Constitutional symptoms: Anorexia, fever
What are the signs of Wilm’s tumour
Hypertension
Signs of anaemia (haemorrhage into mass)
Abdominal mass: Smooth and firm
What are the differentials for Wilm’s tumour
Faeces (most common cause of abdo mass - usually craggy, mobile and in lower abdo)
Neuroblastoma (most arise in the abdo (adrenal gland or retroperitoneal symp ganglia) - causes discomfort and have FLAWS symp)
What investigations should be done for Wilm’s tumour
Urine Dip
Coagulation screen: prolonged APTT (vWD)
USS
CT/MRI
Note: avoid biopsy, highly vascular
What is the management for Wilm’s tumour
Nephrectomy + chemotherapy (± radiotherapy prior to surgery if advanced disease)
What is the prognosis for Wilm’s tumour
Excellent, survival of 90%
Mets found in 20% of patients (Most commonly lung)
How is Wilm’s tumour staged
1 = limited to kidney, completely excisable
2 = not limited to kidney, completely excisable
3 = not limited to kidney, not completely excisable
4 = spread beyond abdomen, haematogenous metastasis
5 = bilateral (each tumour graded separately)
What is the difference in presentation of glomerular vs lower urinary tract haematuria
Glomerular haematuria is suggested by:
- Brown urine
- Presence of deformed RBCs- occurs as they pass through the basement membrane
- Casts
- Often accompanied by proteinuria
Lower urinary tract haematuria is suggested by:
- Red urine
- Occurs at the beginning or end of the urinary stream
- NOT accompanied by proteinuria
- Unusual in children
