Haematuria Flashcards
The management of patients with haematuria is often difficult due to the absence of widely followed guidelines. It is sometimes unclear whether patients are best managed in primary care, by urologists or by nephrologists.
What are different types of haematuria?
- Microscopic or dipstick positive haematuria → non-visible haematuria
- Macroscopic haematuria → visible haematuria
What are causes of transient or spurious non-visible haematuria?
- UTI
- Menstruation
- Vigorous exercise
- Sex
What are causes of persistent, non-visible haematuria?
- Cancer
- Stones
- Benign prostatic hyperplasia
- Prostatitis
- Urethritis
- Renal causes (IgA nephropathy)
What are spurious causes of haematuria?
Red/orange in urine, where blood is not present on dipstick
- Food → beetrot, rhubarb
- Drugs → rifampicin, doxorubicin
What are malignant causes of haematuria?
- Renal cell carcinoma (remember paraneoplastic syndromes)
- Urothelial malignancies - 90% transitional cell carcinoma
- Squamous cell carcinoma + adenocarcinoma - rare bladder tumours
- Prostate cancer
- Penile cancers (SCC)
What is the choice of testing for detecting haematuria?
- Urine dipstick
- Others → renal function, A:CR, P:CR, BP, urine microscopy
How is persistent non-visible haematuria defined as?
Blood being present in 2 out of 3 samples, tested 2-3 weeks apart
What does painless visible haematuria indicated?
- Bladder cancer
- Refer urgently
According to NICE guidelines, who should be urgently referred (within 2 wks)?
- Aged >45 years AND:
- Unexplained visible haematuria without UTI, or
- Visible haematuria that persists or recurs after successful treatment of UTI
- Aged >60 years AND have unexplained nonvisible haematuria and either dysuria or a raised WCC
According to NICE guidelines, who should be given a non-urgent referral?
Aged > 60 years with recurrent or persistent unexplained UTI
