Haematuria Flashcards
What is haematuria?
Blood in the urine
What is visible and non-visible haematuria called respectively?
Visible - macroscopic/gross
Non visible - microscopic/dipstick positive
When is haematuria diagnosed?
Presence of at least 5 red blood cells per high powered field in 3 consecutive centrifuge specimens obtained at least 1 week apart
OR
Dipstick (usually dipstick tbh)
What is spurious contamination?
Discoloured urine caused by contaminants (blood, etc) from a non-urinary tract source
List some lower urinary tract symptoms that may present in conjunction with haematuria
Hesitancy
Frequency
Urgency
Dysuria
List some upper urinary tract symptoms that may present in conjunction with haematuria
Renal colic (loin to groin pain)
List causes of red appearing spurious contamination?
Menstruation Food (rhubarb, beetroot) Myoglobin in urine Drugs Toxin (lead, mercury)
How much blood does it take to give the urine a red appearance?
1ml
When is myoglobin found in the urine?
Bywater’s syndrome (crush syndrome)
Rhabdomyolisis (statins)
McArdle sydrome
I.e damage to muscles
Which drugs can cause spurious contamination?
Nitrofurantoin (UTI treatment)
Rifampicin
Chloroquine
Senna containing laxatives
List the appearance of brown appearing spurious contamination
Porphyrias
Urobilinogen in urine
When is urobilinogen found in urine?
Liver dysfunction
Icterus
Haemolysis
Blood thinners increase incidence of haematuria. T/F
True in overdose - warfarin, heparin & aspirin
Which percentage of patients with frank haematuria have cancer?
20-30%
What are the risk factors for serious pathology of the urinary tract?
Smoking Chemical/dye exposure Gross haematuria >40 y/o History of urologic disorder History of irritative voiding symptoms History of UTI (reassuring) Analgesia abuse
Cystitic can cause frank haematuria. T/F
True
What are the infective causes of haematuria?
Uretitis Cystitis Ureteritis Pyelonephritis Prostatitis
Can glomerulonephritis cause haematuria?
Yes - autoimmune in origin
When does prostatitis cause haematuria?
When it is associated with UTI
Trauma to blood vessels
Do UT stones cause haematuria? If so, which type?
The majority of the time - microscopic
Can renal tumours cause haematuria? If so, which type?
Yes - commonly frank but either
What is the isreal triad?
Pain
Kidney mass
Haematuria
Usually at least one will be present in kidney tumours
What types of kidney tumours are there?
Renal cell cancer (renal parencyme)
Transitional cell cancer (renal pelvis, calycs, etc)
How do tumours of the lower urinary tract present?
Haematuria
Retention
Urinary irritative symptoms
Loin pain
What is sports/joggers haematuria?
Haematuria presenting in patients who do non-contact sport due to vasoconstriction of renal vessels particularly the efferent renal arteriole
(–> hypoxic damage to kidney and increased glomerular filtration pressure)
What is the natural history of joggers haematuria?
Disappears within a week
Can contact sports cause joggers haematuria?
No. But can cause haematuria through trauma
What is decompression haematuria?
Occurs when bladder drained too quickly by catheterisation causing rupture of blood vessels
Foreign bodies lodged in the urinary tract can cause haematuria. T/F
True
Which questions should be asked on taking a history of a patient with haematuria?
Gynaecological & surgical history Pneumonuria Faecaluria Vaginal bleeding Abdominal and/or loin pain Weight loss Anaemia
When do pneumonuria and faecaluria occur?
Pneumonuria - fistula
Faecaluria - fistula (e.g vesico-diverticular)
Which aspects of the history are important for generating a differential?
Sex (UTI in females ; prostate in males) Age (benign ; cancer) Trauma Country (schistomosis, aristochola) Bleeding disorders Phenacetin abuse (cocaine addicts) History of UTI Occupation
How does a ruptured kidney present?
Loin pain
Haematuria
Trauma
Malaise
How does a ruptured kidney present on CT?
Lots of dark bleeding surrounding where kidney should be
How does the colour of urine give a hint as to which pathology?
Dark blood with clots - old pathology
Fresh red blood - something happening right now
What do veriform (“worm-like”) clots indicated?
Bleeding coming from upper urinary tract
esp if associated with loin pain - renal colic on passing clots
How does the timing of the blood help differentiate pathology?
Initial - urethra/prostate
Terminal - urethra/prostate/terminal vesicles/bladder neck
Total - bladder/kidney/ureter
How does pain pattern help differentiate pathology?
Flank - pyelonephritis/renal nephrolithiasis
Radiates to groin - renal stones
Suprapubic - bladder stone
How can haematuria be investigated?
Urinalysis Urine culture Cytology Bimanual palpation PR exam Urinary x-ray dye test CT urogram (with/without contrast)
How is traumatic haematuria investigated?
CT scan (first line)
USS
MRI
