Haematuria

Question 1

Is haematuria a normal finding?

Answer 1

Never

Question 2

Classifications

Answer 2

Visible haematuria VH aka macroscopic or gross

Non-visible haematuria NVH aka microscopic or dipstick +ve

Question 3

Classifications of NVH

Answer 3

Symptomatic NVH with suprapubic pain or renal colic

Asymptomatic NVH

Question 4

What is pseudohaematuria

Answer 4

Red or brown urine that is not due to haemoglobin

Can be due to rifampicin, methyldopa, hyperbilirubinuria, myoglobinuria and certain foods like beetroot or rhubarb.

Question 5

Most common causes

Answer 5

UTI

Urothelial carcinoma

Stone disease

Adenocarcinoma of the prostate

BPH

Question 6

Urological causes of haematuria

Answer 6

Infection

Malignancy

Renal calculi

Trauma or recent surgery

Radiation cystitis

Parasitic due to schistosomiasis

Question 7

Clinical features

Answer 7

Make sure you know the degree of haematuria - Bright pink, orange or dark brown may suggest non-urological causes

The timing of the blood in the stream -> Total suggests bladder or upper tract, if it is just terminal haematuria suggest potential severe bladder irritation.

Ask about LUTS, fever, rigors, suprapubic pain, flank pain or weight loss or recent trauma

Question 8

DH and SH

Answer 8

Drug history

Smoking status

Industrial carcinogens

Recent foreign travel

Question 9

Examination findings

Answer 9

Abdo exam + DRE and/or examination of the external genitalia

Question 10

Initial investigations

Answer 10

Urinalsysis (nitrites +/- leukocytes indicates infection)

Bloods - FBC, U&Es, clotting

PSA might be done

Check A:C ration or protein:crea ratio

US-KUB if idnicated

Question 11

What indicates urgent referral to urological service?

Answer 11

Aged >45yrs with either….

Unexplained haematuria without UTI

Visible haematuria that persists or recurs after successful treatment of UTI

or….

Aged 60yrs with unexplained non-visible haematuria and either dysuria or raised WCC on bloods

Question 12

When should referral to nephrologist be done

Answer 12

With likely nephrological diagnosis

Evidence of declining GFR

Stage 4 or 5 CKD

Proteinuria with haematuria

<40 yo with HTN

Question 13

Specialist investiations

Answer 13

Flexible cytoscopy = gold standard for assessing lower UT

Urine cytology

Upper UT imaging by…

US KUB imaging

CT urogram is more definitive although with a higher radiation exposure.

Question 14

Management

Answer 14

Treatment of underlying pathology