Haematuria

Question 1

Wha is NVH defined as?

Answer 1

> 3 RBH / high power field on microscopy

(deemed significant if 1+ on urine dip test)

Question 2

Wht does Urine test for when checing for haematuria??

Answer 2

Haem & Myogloin (false positive, also: Bacterial peroxidases, povidone, hypochlorite)

Question 3

What can give false positive on urine dip test for haematuria?

Answer 3

ascorbic acid , Vit C

Question 4

What does 1+ RBC on dip test equate to on HPF?

Answer 4

1-40

(++ Rbc = 10-40, +++ RBC = 40-100)

Question 5

What percentageof patients with NVH have no abnormality found?

Answer 5

70%

Question 6

When is it advisd to refer to nephrology?

Answer 6

eGFR < 60 ml/min
BP >140/90
proteinurea (Cr > 50mg/mmol or ACR > 30 mg/mmol)

Question 7

What causes BPH to increase vascularity of the prostate?

Answer 7

VEGF - this elevated expression increases prostate vascularity (Finasteride decreases VEgf and reduced blood flow

Question 8

Which Medication acts on VEGF on the prostate?

Answer 8

Finasterite reduces expression of VEGF and in turn decreased microvascualr density and bloodflow

Question 9

What are the nice refferral guidance for haematuria?

Answer 9

• > 45ye - unexplained VH without uti,
• > 45yo - VH persistant after UTI
• > 60 yo unexplained NVH & raised WCC & dysuria

Question 10

Which factors have highest Pv for patients with bladder cancer

Answer 10

Raised WCC (PPV = 3.9, dysuria (PPV = 4.5)

price et al 2014

Question 11

Cytology - what is improtant when taking it?

Answer 11

Take mid morning
Whole stream
If catheter used - saline washouts fixed in formulin
be fast

Question 12

What are 4 new urine cystology markers being evaluated?

Answer 12

Nulear matric protein 22 (NMP22)
Bladder tumour associated antigen (BTA stat) -> tehse identify overproduction of compliment protective peptide

Telomerase Repeat Amplification TRAP

Urovysion FISH ch 3,7,17

Question 13

Name 5x glomurlar causes of (nephrological ) haematuria?

Answer 13

Bergers disease (IgA nephropathy)

Alports syndrome X Linked collagen mutation -> nephritis)

Goodpastures syndrome (Autoimmune disease - basement membrate attack)

Nephrotic syndrome - non inflam injury to glomeru (Proteinurea,hypoalbuminaemia, hypercholesterolaemia, hyperlipidaemia)

Hennoch schoenlein purpura - vasculitis

Question 14

POST CARD

Name non - glomerular causes of haematuria (mnemonic)

Answer 14

P - Pyelonephritis
O - Obstructive uropathy
S - Sickle cell
T - Trauma / TB
C - Cirrhosis
A - Canalgesic nephropathy
R - Renal vein thrombosis
D - Diabetes