Haematuria Flashcards
What should haematuria in adults be considered a symptom of until proven otherwise?
Malignancy
What are the types of visible haematuria?
Macroscopic haematuria, gross haematuria
What are the types of non-visible haematuria?
Microscopic haematuria, dipstick positive haemtauria
How is non-visible haematuria classed?
Symptomatic and asymptomatic (incidental finding)
What are some of the symptoms of non-visible haematuria?
LUTS = hesitancy, frequency, urgency, dysuria UUTS = renal colic
How common is frank haematuria?
40% of all urology referrals = 40% caused by significant abnormalities, 20% caused by malignancy
What is the aetiology of microscopic haematuria?
Prevalence = 2.5-13%
Unknown aetiology in 61-77%
Genito-urinary malignancy in 0.43-5%
UUT carcinoma in 0-0.1%
What is microscopic haematuria defined as?
Three or more red blood cells per high power field on microscopic evaluation from two of three specimens
What are some risk factors for microscopic haematuria?
Smoking, exposure to chemicals or dyes, history of gross haematuria, age >40, history of urological disorders, history of voiding symptoms, recurrent UTIs, analgesic abuse
What effect do inflammatory changes have on blood flow?
Increases blood flow to the infected organ
What are some common renal infections?
Urethritis, prostatitis, cystitis, ureteritis, pyelonephritis, glomerulonephritis
Why do tumours bleed?
Form new vessels
Increased vessel density in tumour
Abnormal vessels = bleed more easily
How common is haematuria in patients with renal cell carcinoma?
50-60% present with haematuria
What is the Israel triad of renal cell carcinoma symptoms?
Haematuria, pain, mass = occurs in <10%
What are some symptoms of urological tumours?
Haematuria (75-85%), loin pain, renal colic, retention of urine, urinary irritative symptoms
How may trauma cause haematuria?
Bleeding around kidney (perirenal haematoma) may cause haematuria if the pelvicalyceal system is breeched
What causes sport haematuria?
Renal or bladder trauma due to sport (both contact and non-contact) = common
What vessel changes occur in sports haematuria?
Vasoconstriction of renal vessels = hypoxic damage to nephrons
Constriction of efferent arteriole = increased filtration pressure
Increased glomerular permeability
How common is sports haematuria after long distance running?
Occurs in 24% = resolves in 7 days
What kind of haematuria occurs in sports haematuria?
Microscopic in up to 95% = due to red cell haemolysis and rhabdomyolysis in 80%
How often does sporting injury cause renal trauma?
30% of renal trauma is due to sporting injuries
Why should sports haematuria always be investigated?
Due to risk of underlying urinary tract injury and other incidental findings
What is loin pain haematuria syndrome?
Periods of severe unilateral pain that radiates to abdominal area, medial thigh or groin = lasts for hours or is constant
What are some other symptoms of loin pain haematuria syndrome?
Dysuria, vomiting, low grade fever = not associated with UTI
What is loin pain haematuria syndrome associated with?
Disease of the peripheral arteries
When does decompression haematuria occur?
After catheterisation for chronic urinary retention = usually transient and mild, but can be massive and need transfusion
What causes decompression haematuria?
Sudden drop in pressure in the damaged bladder
What are important aspects of the history to cover in a patient with haematuria?
Gynaecological and surgical histories, pneumaturia, faecaluria, PV bleeding, abdominal/loin pain, blood thinners or bleeding disorders
What are some causes of spurious contamination that may make urine red?
Menstrual blood
Food = beetroot, blackberries, rhubarb
Myoglobin in urine
Drugs and toxins (lead, mercury)
What are some causes of myoglobin in urine?
Rhabdomyolysis, McArdle syndrome, Bywater’s syndrome
What are some drugs that can turn urine red?
Doxyrubicine, chloroquine, rifampicin, nitrofurantoin
How common is haematuria in healthy children?
Macroscopic haematuria occurs in 3-5% of healthy children
What causes red diaper syndrome?
Serratia marcescens infection
What are some common causes of haematuria in children?
UTI, trauma, perineal irritation
What are some rarer causes of haematuria in children?
Sickle cell disease, nephrolithiasis, glomerulonephritis, malignancy, urologic abnormalities, coagulopathies, drug-induced cystitis
What are some features of Wilm’s tumour?
Most common malignancy in patients <15 years old
70-80 cases each year in UK
90% survival rate
What are the symptoms of Wilm’s tumour?
Frank haematuria = 20%
Fever, abdominal mass, hypertension, malaise
What are some factors to consider as to why a patient has haematuria?
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
What are some symptoms of a UTI?
Loin pain, frequency, urgency, dysuria, feeling feverish, sweating, shivery
What is the strongest risk factor for developing urothelial cancer?
Smoking
What occupations are associated with an increased risk of developing urothelial cancer?
Autoworkers, painters, truck drivers, leather workers, metal workers, dry cleaners, dental technicians, barbers, beauticians, hair dressers, plumbers
What features of the timing of a patient’s haematuria should you ask about?
Initial, terminal, total
What signs indicate upper urinary tract haematuria?
Veriform clots and flank pain
What are some features of the examination of a patient with haematuria?
Look for bruising/swelling of loin, abdomen, scrotum or perineum
Palpate for tenderness or mass of kidney
PR examination for prostate
What investigations can be done for haematuria?
Urinalysis, culture and sensitivity, USS, CT, MRI, cystoscopy, ureterorenoscopy
Urogram = IV, CT, MRI
What patients should be urgently referred on the suspected cancer pathway?
All patients >45 with visible haematuria
All patients >60 with symptomatic non-visible haematuria
What patients should be referred to urology?
All patients with visible haematuria or symptomatic non-visible haematuria
All patients aged >= 40 with asymptomatic non-visible haematuria
When should patients be referred to nephrology?
Evidence of declining renal function
Chronic kidney disease
Significant proteinuria
Isolated haematuria with hypertension >= 40 years old
Visible haematuria coinciding with intercurrent infection
