Haematuria Flashcards
Classification of haematuria
- Visible (VH) - pink, red or dark brown urine
- Non-visible haematuria (NVH) - blood present on urinalysis
Classification of non-visible haematuria
- Symptomatic NVH (s-NVH) - associated symptoms eg suprapubic pain or renal colic
- Asymptomatic NVH (a-NVH) - no symptoms
Most common causes of haematuria
- UTI
- Renal/bladder/prostate cancer
- Renal calculi
- BPH
Less common causes haematuria
- Trauma
- Radiation cystitis
- Parasite - eg schistosomiasis
- Medical - GN, HUS
Anatomical classification of haematuria causes
- Urological - upper vs lower tract
- Non-urological - medical vs pseudohaematuria
What is pseudohaematuria?
- Red/brown urine not secondary to presence of haemoglobin
- Causes inc medication (rifampicin, methyldopa), myoglobinuria, hyperbilirubinuria, certain foods eg beetroot or rhubarb
What to ask about haematuria?
- Degree - quantified often using colours of wine
- Timing in the stream it occurs - total suggests bladder/upper cause, terminal suggests severe bladder irritation
Associated symptoms to ask about for haematuria
- LUTS
- Fevers/rigors
- Suprapubic pain
- Flank paun
- Weight loss
- Recent trauma
Things to enquire about in social history for haematuria
- Smoking status - urological malignancy
- Industrial carcinogens eg dyes etc - OCCUPATION
- Foreign travel - schistosomiasis
Drug history for haematuria
- Antiplatelets or anticoags
- BUT still investigate as normal
- Even though slightly higher incidence of bleeding on these medications
Investigations for haematuria
- Urinalysis - urine dip for nitrates/leukocytes suggesting infection
- Baseline bloods - FBC, U&E, clotting
- PSA - after counselling
- UACR if deranged renal function
What is required on dipstick for haematuria?
- Needs to be 1+ or more
- Trace blood does not constitute
When might you refer to nephrology for haematuria?
- Declining eGFR
- Severe CKD
- Proteinuria with haematuria
- Those <40 with hypertension
= nephrological cause?
Criteria for urgent urological referral for haematuria
NICE CKS:
Aged 45 or older with any of:
* Unexplained visible haemturia without infection OR
* Visible haematuria that persists or recurs after successful treatment of UTI OR
* Aged 60 and over who have unexplained non-visible haematuria + dysuria OR raised WCC on blood test
Specialist investigations for haematuria
- Flexible cystoscopy - assess lower urinary tract at “one stop haematuria clinic”
- Urine cytology - look for cancer cells (often more useful in f/u with proven malignancy)
- USS KUB
- CT urogram = CT KUB + contrast
