Haematuria + creatinine

Question 1

2 ww referral

Answer 1

Over 45 with unexplained macroscopic haematuria excluding UTI as cause

Over 60 yo with unexplained microscopic haematuria and dysuria or raised WCC

Question 2

Renal causes of haematuria

Answer 2

Renal:
Congenital: PCK
Trauma
Infection: pyelonephritis
Neoplasm
Immune: GN

Question 3

Extra renal causes of haematuria

Answer 3

Extra-renal:
Trauma: stones, catheter
Infection: cystitis, prostatitis, urethritis
Neoplasm: bladder, prostate

Drugs: NSAIDs, furosemide, cipro, cephalosporins

Question 4

Ix

Answer 4

Bloods - PSA
DRE
USS - masses
CT urogram - upper tract tumours 
Cystology

Question 5

Proteinuria

Answer 5

30mg

Cr:Alb > 30mg

Question 6

Causes of proteinuria

Answer 6

DM

Nephrotic syndrome:

• Minimal change
• Membranous

Amyloidosis
SLE
HTN
UTI

Question 7

Creatinine

Answer 7

Creatinine is synthesised during muscle turnover

Freely filtered and small proportion secreted by PCT

Used for AKI monitoring

Question 8

eGFR

Answer 8

Monitor CKD

Modified for sex, age, race

Question 9

Asymptomatic Haematuria

Answer 9

1. IgA Nephropathy
2. Thin BM
3. Alport’s

Question 10

IgA Nephropathy / Berger’s Disease

Answer 10

Features:
- Young male with episodic macroscopic haematuria
occurring a few days after URTI

• Rapid recovery between attacks
• ↑IgA

Can occasionally cause nephritic syndrome

Biopsy: IgA deposition in mesangium

Rx: Steroids or cyclophosphamide if ↓renal function

Question 11

Thin BM Disease

Answer 11

Autosomal dominant
Commonest cause of asymptomatic haematuria

Features

• Persistent, asymptomatic microscopic haematuria
• V. small risk of ESRF