Haematuria

Question 1

What is the definition of the following:
- Macroscopic haematuria
- Microscopic haematuria
- Haemoglobinuria
- Myoglobinuria

Answer 1

• Macroscopic haematuria: Visible blood
• Microscopic haematuria: Blood only detectable via urinalysis
• Haemoglobinuria: Occurs due to haemolysis of rbcs
• Myoglobinuria: Occurs due to breakdown of muscle

Question 2

What are the causes of pseudohaematuria?

Answer 2

Meds - Rifampicin, doxorubicin, phenytoin
Dietary items eg, berries and beets
Myoglobin
Menstruation

Question 3

What are the kidney related causes of haematuria?

Answer 3

Glomerular: IgA nephropathy, Alport’s syndrome, Glomerulonephritis
Non-glomerular: Tumours, renal stones, infection, PCK disease, urethral stricture, sickle cell

Question 4

What are the ureteric/bladder causes of haematuria?

Answer 4

Stones, tumours, strictures and infection

Question 5

What are the urethral causes of haematuria

Answer 5

BPH, prostatic cancer, prostatitis, trauma

Question 6

What are some other causes of haematuria

Answer 6

Sexual intercourse, anticoagulants, viral illnesses, Tuberculoss

Question 7

What are the differentials for haematuria?

Answer 7

Glomerular disease,
Non-glomerular kidney disease
Ureteral stones
Urethral conditions
Pseudohaematuria

Question 8

What are the investigations for haematuria?

Answer 8

Urinalysis, urine culture, urine microscopy, bloods including PSA and coagulation screens, imaging (renal US, CT KUB), ACR.PCR, blood pressure, cystoscopy or renal biopsy.
Management will depend on cause

Question 9

Who needs an urgent referal for haematuria?

Answer 9

1. Age > 45 and visible haematuria without infection or visible haematuria that persists after UTI treatment.
2. Age > 60 and have unexplained microscopic haematuria and high WCC or dysuria