Hematuria Flashcards
What are frequent causes of hematuria?
Transient unexplained
UTI
Stones
Cancer
What are less frequent causes of hematuria?
Exercise Trauma Endometriosis Sickle Cell Disease PCKD Glomerular disease
What are risk factors for malignancy?
Similar to earlier
Alcohol can be protective
What should be done with red urine?
Spin it
Sediment=hematuria
Supernatant=need to dipstick for heme
What should be done with red urine with a negative dipstick?
Porphyria
Phenazopyridine
Beets
What should be looked for with red urine with a positive dipstick?
Plasma clear=myoglobinuria
plasma red=hemoglobinuria
What are indicative of glomerular bleeding?
Red cell casts
Proteinuria
Dysmorphic appearing red cells
Smokey brown or “coca cola” urine
What is indicative of extraglomerular bleeding?
Clots
What is the cause of ~50% of unexplained hematuria?
Glomerular disease
What are unusual causes of hematuria?
Arterio-venous malformations
Fistulas
*Loin pain-hematuria syndrome (abnormal GBM with a possible association with intratubular crystal formation)
What are the most common causes of persistent microscopic hematuria in kids?
Glomerulopathies: IgA Nephropathy; Alport’s syndrome; Thin basement membrane disease; Post-infection GN
Hypercalciuria: urine calcium/creat>0.2
Nutcracker syndrome (left renal vein compression by the aorta and superior mesenteric artery…more common in Japan)
Who is most likely to have stones?
Old white men
What are risk factors for calcium stone formation?
Hypercalciuria Hyperuricosuria Hypocitraturia Low urine volume Increased Oxalate excretion (low calcium diet, absorptive hypercalciuria, enteric hyperoxaluria)
What medical problems are associated with calcium stone formation?
Primary hyperparathyroidism
Medullary sponge kidney
Distal renal tubular acidosis
What is the dietary treatment for calcium stones?
Fluid Salt Protein Calcium Oxalate
What are some medications used to prevent calcium stones?
Thiazide diuretics Potassium citrate or bicarb Orthophosphate Allopurinol/Febuxostat Calcium carbonate
Are uric acid stones visible on x-ray?
No…they are radiolucent
What causes uric acid stones?
Hyperuricosuria
Acidic urine
How are uric acid stones treated?
Urine output > 2L/day
Alkalinization of the urine
Allopurinol/Febuxostat
What do magnesium ammonium phosphate crystals look like?
Coffin lids
What is needed to form struvite stones?
Increased ammonia production
Increased urine pH (decreases solubility of phosphate)
UTI–Proteus and Klebsiella most common
How are struvite stones treated?
Perpetual antibiotics
Acetohexemic acid–urease inhibitor
ESWL/percutaneous nephrolithotomy
What do cystine crystals look like?
Hexagons
What causes cystinuria?
Auto recessive trait
What are the three types of cystinuria?
I- parents excrete normal amount of cystine (mutation on chromosome 2)
II- parents excrete large amounts
III- parents excrete intermediate amounts
What are clinical manifestations of cystine stones?
Radio-opaque (fuzzier than calcium)
Can form staghorn calculi
How are cystine stones treated?
Drinking > 3L/day Alkalinization of urine Reduced Na intake Penicillamine Tiopronin (mercaptoproprionylglycine) Captopril
When is the first stone treated?
Only if it is metabolically active
