Hematuria

Question 1

Common etiology

Answer 1

Benign prostatic hyperplasia (BPH)
Urinary tract infection
Acute pyelonephritis
Alport's syndrome
Bladder cancer
Prostate cancer
Kidney stone
Instrumentation of the urinary tract
Menstruation

Question 2

Red flags

Answer 2

Bladder cancer
 Prostate cancer
 Renal trauma
 Bladder trauma
 Urethral trauma
 Sickle cell anaemia
 Coagulopathy
 Arterial-venous malformation
 Renal vein thrombosis
 Extrapulmonary tuberculosis
 Post-infectious glomerulonephritis
 Membranoproliferative glomerulonephritis
 Rapidly progressive glomerulonephritis
 Systemic lupus erythematosus
 Renal cancer
 Metastatic cancer
 Urethral cancer
 Penile cancer
 Placenta percreta
 Cytotoxic medications

Question 3

Important history

Answer 3

Age
Gender->mensturation, UTI, BPH/Prostate
Timing: initial, terminal or total
LUTS->dysuria, urinary frequency, urgency, and urethral discharge->infection, BPH (UTI, stones)
Pain
Recent vigorous activity
Inflammatory/cytotoxic medications
Exposure to smoke/industrial chemicals.
Periorbital and peripheral edema, weight gain, oliguria
Recent pharyngitis or skin infection
Joint pain, skin rashes, low grade fevers
Risks for STD
FHx->stones, cancer, prostate enlargement, SCA, collagen vascular disease, renal disease
Recent urologic interventions

Question 4

What does initial, terminal or total hematuria indicate

Answer 4

Initial and terminal haematuria represent bleeding from the urethra, prostate, seminal vesicles, or bladder neck. Total haematuria, which is present throughout the void, indicates bleeding of bladder or upper tract (kidney or ureteral) origin.

Question 5

Physical examination

Answer 5

Vitals->hemodynamically stable, T
Pallor->anemia
Periorbital, scrotal and peripheral edema
Cachexia
Suprapubic tenderness
Costovertebral angle tenderness
Palpable bladders
DRE->prostate
Adenopathy
Catheter

Question 6

Investigations

Answer 6

Urinalysis->dip stick, microscopy, cultures, cytology, repeated, followed by microscopic evaluation of urinary sediment if positive
FBE
Coagulation studies

Depending on history:
Complement, ANA, Hep B/Hep C, HIV, Hb electrophoresis, anca->dependant on history
ASOT
CT urography
Cystoscopy

Send for urologist
If +dysmorphic, proteinuria, red cell casts, renal insuffienciency->nephrologist

Question 7

When is complement low

Answer 7

Low serum complement levels are seen in post-infectious glomerulonephritis, SLE nephritis, bacterial endocarditis, and membranoproliferative glomerulonephritis

Question 8

Exaplanation to patient about investigating microscopic hematuria

Answer 8

A complete w/u is necessary to evaluate for the presence of conditions such as infections or tumors, but should be reassured that the incidence of cancer presenting as painless microscopic hematuria is low

Question 9

Glomerular hematura urine

Answer 9

1. Erythrocyte casts
2. Dysmorphic RBCs
3. Proteinuria

Question 10

How does renal hematuria urine compare to glomerular

Answer 10

1. Proteinuria as well

2. Absence of RBC casts and proteinuria

Question 11

What are important causes of interstitial nephritis and what finding on analysis indicates this

Answer 11

1. Analgesics and other drugs

2. Presence of eosinophils

Question 12

Advise when needing to repeat the urinalysis

Answer 12

1. Avoid potential confounders_>menses, medications, exercise for 72 hours, nutritional/herbal, sexual intercourse

Question 13

If UTI found

Answer 13

Treat and repeat urinalysis in 6 weeks->if resolves, no further investigation necessary

Question 14

Is contrast used to visualise stones

Answer 14

No->non contrast CT

Question 15

If patients have negative thorough w/u what are the f/u options

Answer 15

1. Blood pressure
2. Urinalyses
3. Voided urine cytology

6, 12, 24, 36 months