Haematuria Flashcards
Haematuria is
blood in urine
Categories of haematuria?
Macroscopic/ frank/ gross/ visible
Microscopic/ non-visible/ dipstick positive
Macroscopic or microscopic can either be asymptomatic or symptomatic
When is haematuria diagnosed?
when presence of 5 or more red blood cells per high power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart
Name 7 things other than blood that can make urine look red?
1) Menstrual bleeding
2) Food- beetroot, blackberries, rhubarb
3) Myoglobin in urine: due to rhabdomyolysis, McArdle syndrome, Bywaters syndrome (Crush Syndrome)
4) Drugs- doxyrubicine, chlorqine, rifampicin, nitrofurantoin, senna containing laxatives
5) Toxins- lead or mercury
6) Brown staining of urine due to urobilonogen in urine (haemolysis, icterus, liver dysfunction) or porphyria
7) Some bleeding disorders and blood thinners can make people prone to bleeding so can bleed from urinary tract.
Why are so many patients with haematuria reviewed at clinic?
20-30% of patients with urine in their blood have cancer
In someone with microscopic asymptomatic haematuria what would still make you worried? Name 8 factors.
Smoking Occupational risk factors e.g. chemical and dyes History of gross haematuria Age more 40 yo History of urologic disorder or disease History of irritative voiding symptoms History of urinary tract infection Analgesic abuse
Name 4 benign causes of haematuria?
Infection of any part of tract
Bladder/ kidney stones if they scratch the mucosa
Sport haematuria- due to contact or joggers haematuria
Decompression haematuria
Describe sports haematuria
Contact sport haematuria- basically due to some sort of kidney trauma
Joggers haematuria occurs in long distance runners due to hypoxia and vasoconstriction on a long distance run. Will have the haematuria after running and then takes about 1 week to resolve.
Describe decompression haematuria
If drain bladder quickly after retention can damage blood vessels- haematuria after insertion of catheter. This is why when inserting a catheter should drain slowly.
What non urinary tract causes can cause haematuria?
Cancers sitting next to urinary tract which invades and then bleeds or other things such as diverticuli- need a comprehensive history.
Haematuria associated with loin pain and a flank mass is the classic triad for?
Renal cell carcinoma
Haematuria is more common in renal cell carcinoma or transitional cell carcinoma?
Transitional cell carcinoma
Fresh red blood vs dark red blood with clots?
Fresh red blood suggests problem currently ongoing
Dark red blood with clots suggests old blood and problem may be in process of resolving
Vermiform clots (wormlike) have come from the _____
upper urinary tract
Vermiform clots and flank pain?
Renal colic/ stones
