Haematuria

Question 1

What is visible haematuria

Answer 1

Frank haematuria - pts can see this when they urinate

Question 2

What is non - visible haematuria

Answer 2

Pts cannot see this when they urinate, microscopic and only picked up on urine dipstick

Question 3

What is the risk of cancer with visible haematuria

Answer 3

20%

50% with clots

Question 4

What is the risk of cancer with non visible blood

Answer 4

5%

Question 5

What are the components of Urine dipstick - 9 marks

Answer 5

Blood 
Glucose
Protien 
ketones 
Nitrates 
Leukocytes
PH
SG 
Urobilinogen

Question 6

What is the significance of each feature of urine dipstick

Answer 6

Blood - glomerulonephritis 
Glucose - DM 
Ketones - DKA
PH - stone formers 
SG - endocrine disorders 
Proteins - nephrotic and CKD 
Nitrates - UTI ( more specific )
Leukocytes - UTI ( more sensitive ) 
Urobilnogen ( post hepatic jaundice)

Question 7

Which Ph favours which stone formation

Answer 7

Acid => urate stone

Alkali = calcium stones and phosphate

Question 8

What are some causes of false positive urine dip for blood

Answer 8

Exercise, menses, myoglobin

Question 9

what are some causes of false negatives of blood on urine dip

Answer 9

Vit C

Heavy proteinuria

Question 10

What is important to ask in a history of haematuria

Answer 10

Pain or painless ( painless suggests bladder cancer ) 
Spaghetti clots - from ureter 
Occupation - dye industry 
Smoking - most biggest risk factor 
FH 
FH - anticoagulants

Question 11

What are the different imaging studies you can do for haematuria

Answer 11

Flexible cystoscopy
CT urogram
USS

Question 12

What is USS used for

Answer 12

Detection of Renal masses mainly
Hydronephrosis
Bladder masses only if bladder is full tho
Not accurate for Upper tract TCC

Question 13

What is flexible cystoscopy used for

Answer 13

Look for any masses in the Bladder - is able to take biopsy too

Question 14

What is CT urogram and when is it used

Answer 14

2 phases in this - non constrast and delayed post contrast phase.
You give patient Constrast - wait and then take CT scan ( this is the non constrast phase) after a while the contrast will be in the kidney then take another Scan - used for Upper TCC

Used when USS and flex cystoscopy is negative

Question 15

Who should be refered where

Answer 15

all pts with visible haematuria - urology
Pts above 40 with non-visible haematuria- urology
Pts under 40 - do USS to rule out urology cause. If normal then send to nephrology

Question 16

What are the causes of haematuria

Answer 16

T - tumour ( malignant ) 
I - infection 
T - trauma 
S - stones 
Others - IgA Nephropathy