Hematuria

Question 1

Types of hematuria, causes?

Answer 1

●Microscopic
1. Glomerular/kidney:
a. IgA nephropathy
b. Thin membrane disease

2. Non-glomerular/urological
   a. BPH, Calculi, Bladder carcinoma

●Macroscopic
1. From kidney, ureter, bladder, prostate
2. Bladder/kidney cancer

Question 2

Approach for hematuria

Answer 2

●?taking anticoagulants or cyclophosphamide (S/E - Cancer)

●Painful - stone/UTI

●Painless - tumour/Cancer

Question 3

Investigations for hematuria

Answer 3

Flow chart

Best: CT-IVP (intravenous pyelogram)
Next best: renal tract USG

Microscopic hematuria: >3 RBC/HPF

For calculi, initial, best inv: CT-KUB

Question 4

Urine sample collection for cytology

Answer 4

3 mid-morning, mid-stream samples
on 3 consecutive days

Question 5

Low risk factors for microscopic hematuria

Answer 5

1. <50yrs age
2. <10 pack-yrs smoking h/o
3. <10RBC/HPF

Repeat urine analysis with in 6 months

Question 6

High risk factors for microscopic hematuria

Answer 6

1. > 50yrs age
2. Smoking
3. Occupational exposure - dyes, benzene,
4. Cyclophosphamide exposure
5. Recurrent urinary symptoms (UTI)
6. Pelvic radiotherapy
7. Gross hematuria

Question 7

When do you repeat microscopy/other investigations for hematuria in UTI, Microscopic with low, high r/f, macroscopic

Answer 7

UTI - 6wks
Microscopic low r/f - 6 months
Microscopic high r/f - CT IVP/RT-USG
Macroscopic - CT-IVP/RT-USG

Question 8

Gold standard test for urinary tract malignancy

Answer 8

CT-IVP

if normal, bladder cancer suspision:
Cystoscopy