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Renal > Haematuria > Flashcards

Haematuria Flashcards

1
Q

What should haematuria in adults be considered a symptom of until proven otherwise?

A

Malignancy

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2
Q

What are the types of visible haematuria?

A

Macroscopic haematuria, gross haematuria

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3
Q

What are the types of non-visible haematuria?

A

Microscopic haematuria, dipstick positive haemtauria

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4
Q

How is non-visible haematuria classed?

A

Symptomatic and asymptomatic (incidental finding)

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5
Q

What are some of the symptoms of non-visible haematuria?

A 
LUTS = hesitancy, frequency, urgency, dysuria
UUTS = renal colic
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6
Q

How common is frank haematuria?

A

40% of all urology referrals = 40% caused by significant abnormalities, 20% caused by malignancy

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7
Q

What is the aetiology of microscopic haematuria?

A

Prevalence = 2.5-13%
Unknown aetiology in 61-77%
Genito-urinary malignancy in 0.43-5%
UUT carcinoma in 0-0.1%

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8
Q

What is microscopic haematuria defined as?

A

Three or more red blood cells per high power field on microscopic evaluation from two of three specimens

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9
Q

What are some risk factors for microscopic haematuria?

A

Smoking, exposure to chemicals or dyes, history of gross haematuria, age >40, history of urological disorders, history of voiding symptoms, recurrent UTIs, analgesic abuse

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10
Q

What effect do inflammatory changes have on blood flow?

A

Increases blood flow to the infected organ

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11
Q

What are some common renal infections?

A

Urethritis, prostatitis, cystitis, ureteritis, pyelonephritis, glomerulonephritis

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12
Q

Why do tumours bleed?

A

Form new vessels
Increased vessel density in tumour
Abnormal vessels = bleed more easily

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13
Q

How common is haematuria in patients with renal cell carcinoma?

A

50-60% present with haematuria

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14
Q

What is the Israel triad of renal cell carcinoma symptoms?

A

Haematuria, pain, mass = occurs in <10%

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15
Q

What are some symptoms of urological tumours?

A

Haematuria (75-85%), loin pain, renal colic, retention of urine, urinary irritative symptoms

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16
Q

How may trauma cause haematuria?

A

Bleeding around kidney (perirenal haematoma) may cause haematuria if the pelvicalyceal system is breeched

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17
Q

What causes sport haematuria?

A

Renal or bladder trauma due to sport (both contact and non-contact) = common

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18
Q

What vessel changes occur in sports haematuria?

A

Vasoconstriction of renal vessels = hypoxic damage to nephrons
Constriction of efferent arteriole = increased filtration pressure
Increased glomerular permeability

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19
Q

How common is sports haematuria after long distance running?

A

Occurs in 24% = resolves in 7 days

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20
Q

What kind of haematuria occurs in sports haematuria?

A

Microscopic in up to 95% = due to red cell haemolysis and rhabdomyolysis in 80%

21
Q

How often does sporting injury cause renal trauma?

A

30% of renal trauma is due to sporting injuries

22
Q

Why should sports haematuria always be investigated?

A

Due to risk of underlying urinary tract injury and other incidental findings

23
Q

What is loin pain haematuria syndrome?

A

Periods of severe unilateral pain that radiates to abdominal area, medial thigh or groin = lasts for hours or is constant

24
Q

What are some other symptoms of loin pain haematuria syndrome?

A

Dysuria, vomiting, low grade fever = not associated with UTI

25
Q

What is loin pain haematuria syndrome associated with?

A

Disease of the peripheral arteries

26
Q

When does decompression haematuria occur?

A

After catheterisation for chronic urinary retention = usually transient and mild, but can be massive and need transfusion

27
Q

What causes decompression haematuria?

A

Sudden drop in pressure in the damaged bladder

28
Q

What are important aspects of the history to cover in a patient with haematuria?

A

Gynaecological and surgical histories, pneumaturia, faecaluria, PV bleeding, abdominal/loin pain, blood thinners or bleeding disorders

29
Q

What are some causes of spurious contamination that may make urine red?

A

Menstrual blood
Food = beetroot, blackberries, rhubarb
Myoglobin in urine
Drugs and toxins (lead, mercury)

30
Q

What are some causes of myoglobin in urine?

A

Rhabdomyolysis, McArdle syndrome, Bywater’s syndrome

31
Q

What are some drugs that can turn urine red?

A

Doxyrubicine, chloroquine, rifampicin, nitrofurantoin

32
Q

How common is haematuria in healthy children?

A

Macroscopic haematuria occurs in 3-5% of healthy children

33
Q

What causes red diaper syndrome?

A

Serratia marcescens infection

34
Q

What are some common causes of haematuria in children?

A

UTI, trauma, perineal irritation

35
Q

What are some rarer causes of haematuria in children?

A

Sickle cell disease, nephrolithiasis, glomerulonephritis, malignancy, urologic abnormalities, coagulopathies, drug-induced cystitis

36
Q

What are some features of Wilm’s tumour?

A

Most common malignancy in patients <15 years old
70-80 cases each year in UK
90% survival rate

37
Q

What are the symptoms of Wilm’s tumour?

A

Frank haematuria = 20%

Fever, abdominal mass, hypertension, malaise

38
Q

What are some factors to consider as to why a patient has haematuria?

A

Trauma, age, gender, nature of haematuria, addiction, occupation, country of residence, urological history, family history of malignancy, history of bleeding disorders, concomitant treatment, recent UTI symptoms

39
Q

What are some symptoms of a UTI?

A

Loin pain, frequency, urgency, dysuria, feeling feverish, sweating, shivery

40
Q

What is the strongest risk factor for developing urothelial cancer?

A

Smoking

41
Q

What occupations are associated with an increased risk of developing urothelial cancer?

A

Autoworkers, painters, truck drivers, leather workers, metal workers, dry cleaners, dental technicians, barbers, beauticians, hair dressers, plumbers

42
Q

What features of the timing of a patient’s haematuria should you ask about?

A

Initial, terminal, total

43
Q

What signs indicate upper urinary tract haematuria?

A

Veriform clots and flank pain

44
Q

What are some features of the examination of a patient with haematuria?

A

Look for bruising/swelling of loin, abdomen, scrotum or perineum
Palpate for tenderness or mass of kidney
PR examination for prostate

45
Q

What investigations can be done for haematuria?

A

Urinalysis, culture and sensitivity, USS, CT, MRI, cystoscopy, ureterorenoscopy
Urogram = IV, CT, MRI

46
Q

What patients should be urgently referred on the suspected cancer pathway?

A

All patients >45 with visible haematuria

All patients >60 with symptomatic non-visible haematuria

47
Q

What patients should be referred to urology?

A

All patients with visible haematuria or symptomatic non-visible haematuria
All patients aged >= 40 with asymptomatic non-visible haematuria

48
Q

When should patients be referred to nephrology?

A

Evidence of declining renal function
Chronic kidney disease
Significant proteinuria
Isolated haematuria with hypertension >= 40 years old
Visible haematuria coinciding with intercurrent infection

Renal (36 decks)

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