Haematuria

Question 1

causes of false haematuria

Answer 1

• Beetroot
• Rifampicin
• Porphyria
• Vaginal bleeding

Question 2

rare causes of haematuria

Answer 2

• Henoch-Schonlein purpura

- bleeding diathesis

Question 3

renal causes of haematuria

Answer 3

• Infarct
• Trauma: inc. stones
• Infection
• Neoplasm
• GN
• Polycystic kidneys

Question 4

ureter causes of haematuria

Answer 4

• stone

- tumour

Question 5

bladder causes of haematuria

Answer 5

• Infection
• Stones
• Tumour
• Exercise

Question 6

prostate causes of haematuria

Answer 6

• BPH
• Prostatitis
• tumour

Question 7

urethra causes of haematuria

Answer 7

• Infection
• Stones
• Trauma
• Tumour

Question 8

specific questions to ask in a haematuria history

Answer 8

1. Timing?
   - Beginning of stream: urethral
   - Throughout stream: renal / systemic, bladder
   - End of stream: bladder stone, schisto
2. Painful or painless?
3. Obstructive symptoms?
4. Systemic symptoms: wt. loss, appetite

Question 9

investigations for haematuria

Answer 9

1. Bloods: FBC, U+E, clotting
2. Urine: dip, MC+S, cytology
3. Imaging
   - Renal US
   - IVU
   - Flexible cystoscopy + biopsy
   - CT/MRI
   - Renal angio

Question 10

causes of asymptomatic haematuria

Answer 10

1. IgA Nephropathy/Berger’s disease
2. Thin Basement Membrane Disease
3. Alport’s syndrome

Question 11

features of IgA nephropathy/Berger’s disease

Answer 11

• most common form of glomerulonephritis
• Young male with episodic macroscopic haematuria
  occurring a few days after Upper Respiratory Tract Infection.
• Rapid recovery between attacks
• ↑IgA
• Can occasionally → nephritic syndrome

Question 12

biopsy results of IgA nephropathy/Berger’s disease

Answer 12

IgA deposition in mesangium

Question 13

treatment of IgA nephropathy/Berger’s disease

Answer 13

steroids or cyclophosphamide if ↓renal function

Question 14

prognosis of IgA nephropathy/Berger’s disease

Answer 14

20% End stage renal disease after 20yrs

Question 15

features of thin basement membrane disease

Answer 15

• Autosomal dominant
• Commonest cause of asymptomatic haematuria
• Persistent, asymptomatic microscopic haematuria
• V. small risk of END Stage renal disease

Question 16

features of Alport’s syndrome

Answer 16

• 85% X-linked inheritance
• Haematuria, proteinuria → progressive renal failure
• Sensorineural deafness
• Lens dislocation and cataracts
• Retinal “flecks”
• Females: haematuria only