Haematuria Flashcards
What is haematuria?
Presence of blood in urine (>3 RBCs/HPF in 2 successive urine samples)
What types of haematuria are there?
Visible (VH)…… Gross or Frank hematuria
Non – Visible (NVH)…. Microscopic or dipstick hematuria
What are rf for malignancy in pt with haematuria?
Risk Factors for Malignancy in Patients with Hematuria
Older age
Male gender
History of cigarette smoking
History of chemical exposure (cyclophosphamide, benzenes, aromatic amines)
History of pelvic radiation
Irritative voiding symptoms (urgency, frequency, dysuria)
Prior urologic disease or treatment
History of chronic indwelling catheters
History of recurrent UTIs
How can haematuria be grouped?
Glomerular: causes arise from the kidney itself.
Nonglomerular, can be further subdivided by whether the process is located in the upper urinary tract (kidney and ureter) or lower urinary tract (bladder and urethra)
What are common causes of glomerular haematuria?
Common Causes of Glomerular Hematuria:
IgA nephropathy (Berger's disease) Thin glomerular basement membrane disease Hereditary nephritis (Alport's syndrome)
What are common causes of non-glomerular haematuria (upper)?
Common Causes of Non-Glomerular Hematuria **Upper Tract: Urolithiasis Pyelonephritis Renal cell cancer Transitional cell carcinoma Urinary obstruction Benign hematuria
What are common causes of non-glomerular haematuria (lower)?
Common Causes of Non-Glomerular Hematuria
**Lower Tract:
Bacterial cystitis (UTI)
Benign prostatic hyperplasia (BPH)
Strenuous exercise (“marathon runner’s hematuria”)
Transitional cell carcinoma
Instrumentation
Benign hematuria (e.g. interstitial cystitis, trigonitis)
Some causes of pseudo-haematuria?
Myoglobinuria
Food coloring (Beets)
Drug related (metronidazole)
Menses
Diseases that most commonly present with symptomatic haematuria
Post-strep glomerulonephritis
Polycystic kidney
Acute pyelonephritis
Kidney trauma
Tract
- stones (pelvis, ureter, bladder)
- cystitis
Diseases that most commonly present with non-symptomatic haematuria
urothelial carcinoma (bladder, ureter and pelvis) BPH Kidney cancer Prostate cancer Clotting disease Exercise induced haematuria Berger's glomerulonephritis Uric acid crystals (hx of renal colic)
LUT symptoms
- Lower urinary tract symptoms (LUTS):
- Dysuria, urinary frequency, urgency, and urethral discharge suggest an infectious or inflammatory process.
- Benign prostatic hyperplasia (BPH) can cause haematuria and lower urinary symptoms such as urinary hesitancy, straining to void, and a sensation of incomplete emptying
What is the importance of pain as a symptom?
Haematuria alone does not cause pain unless it is associated with inflammation or acute urinary obstruction.
Pyelonephritis and renal nephrolithiasis may present as flank pain, often radiating to the groin
Intermittent or total bladder outlet obstruction by a bladder stone or clot can present as suprapubic pain or discomfort.
Haematuria investigation
COMPLETE EVALUATION OF URINARY TRACT IS NEEDED
UUT: Imaging studies
LUT: Endoscopic visualization of the bladder and urethra
- Ideally, the imaging studies are obtained prior to cystoscopy so if there are any abnormalities that warrant further investigation, a patient is not put through unnecessary procedures.
Urine culture: to exclude infection
Imaging: Renal ultrasound to image the upper tracts. CT urography (CTU) in high risk patients: age > 40y,
Cystoscopy
What investigation for UUT and LUT?
Imaging: renal US
Cystoscopy (lower)
Urinalysis in haematuria
Glomerular hematuria = dysmorphic erythrocytes, proteinuria, RBC casts
Nonglomerular medical hematuria = circular erythrocytes, proteinuria, no RBC casts
Nonglomerular surgical hematuria = circular erythrocytes, no proteinuria, no RBC casts
Microscopy is essential
