Hematuria Flashcards
what are the categories of hematuria?
Visible hematuria —> GROSS/FRANK/MACROSCOPIC
- Urine appear, red, brown, tea colored ( person notices it )
Non visible hematuria —-> MICROSCOPIC
- Urine appear normal but RBCS are detected under microscope
less than 3 rbc/hpf —> more than 3 RBC are seen per high power field ( HPF ) under microscope urine sample
what are the types of hematuria based on timing?
Initial hematuria :
Blood appear at the beginning of urination —> Suggests a URETHRAL CASE
Terminal hematuria :
Blood appear at the end of urination —> suggest bladder or prostate cause
Total hematuria :
Blood present throughout urination —>
Suggests a kidney or upper urinary tract cause
visible hematuria
Frank/gross/macro
20-25% due to malignant causes
more concerning than micro
Non visible hematuria
Urine appears normal
5-10% due to malignant causes
less concerning
when do we indicate urine for testing ?
Urinary symptoms ( Lower and upper )
Routine checkup
Testing patient has other disease ( HTN.DM, RENAL FAILURE )
testing methods for non visible hematuria ?
Urine dipstick test
Microscopy
describe urine dipstick?
Initial screening test for hematuria
Detects HEME for RBCS and HB or MYOGLOBIN
the chemical strip change color if certain substances are present or if their levels are above typical levels :
Dipstick test checks for :
Acidity/ concentration ( high not drinking fluid )
Protein ( high = kidney problem )
(bilirubin = liver dam )
Evidence of infection ( WBC, esterase )
BLOOD
QUICK AND EASY BUT MAY GIVE FALSE POSTIIVE
describe microscopy ?
confirms true hematuria
by directly identifying RBCS MORE THAN 3/HPF
Helps differentiate cause:
( glomerular = dymorphic RBCS )
Non glomerular ( isomoprphic RBCS = stones , infections ,tumors )
what is false positive in dipstick testing?
Dipstick detects HEME PIGMENT not RBCS
hemo globin uria ( breakdown of RBCS in blood )
Myoglobin urea ( muscle breakdown
what is discolored urine causes?
Certain foods can cause red/pink urine
Drugs that can cause red urine ( rifampicin, nitrofurantoin , doxorubicin )
Lead or mercury poisoning can cause urine discoloration
what is the etiology of hematuria?
Pre-renal : systemic diseases ( bleeding tendency ) like :
DIC ( sepsis )-> disseminated IV coagulation
Anticoagulants ( Aspirin, warfarin,plavix )
Hematological disroders ( hemophilia, sickle cell
Renal/post renal disease :
Vascular:
AV malformation ( like fistula , abnormal vessels )
Thrombo-embolic = blood clot blocking vessels
KIDNEY :
URETHRA ( Trauama, TB, infection ,inflammation, stone , BPH)
Tumor based on the anatomy :
what are kidney tumors?
Transitional cell carcinoma –> TCC most common ( ASSOCIATED WITH SMOKING, GROSS HEMATORURIA , FLANK PAIN, HYDRONEPHOSIS )
Renal cell carcinoma :
Originate in renal parenchyma but invade renal pevlis/ureter
Symptoms : TRIAD ( HEMATURIA ,FLANK PAIN, PALPABLE MASS ) –> seen in advance cases
only causes bleed when invades
what bladder tumors ?
TCC—> MOST COMMON
Arise from urothelial cells , most common in smokers and indviduals exposed to industrial chemicals
PAINLESS GROSS HEMATURIA –> most common
SCC–> Rare but aggressive
Chronic irritation ( SCHISTOSOMA HEMATOBIUM )
symptoms : Hematuria, dysuria
what are prostate tumors?
adenocarcinoma
most common prostate cancer
invade bladder neck causing hematuria
what are urethra cancers?
Primary urethral cancer ( RARE) = TCC, SCC or adenocarcinoma depending on location
Papillomas ( benign but can bleed )= intermittent hematuria
Genital warts ( HPV lesions
what are the trauma types ?
Blunt type :
Most common
caused by motor vehicle accidents, falls, direct impact
bleeding often subsides spontaenously due to kidney rich blood supply and capsule
Penetrating trauma ( more severe ):
Gunshots wounds, surgical injuries
high likelihood of vascular damage leading to persistent bleeding
graded using AAST
describe bladder ruptures?
High energy trauma ( pelvic fractures )
Intraperitoneal bladder rupture
Extraperitoneal bladder rupture ( most common )
what are the investigations for hematuria?
Urine analysis by dipstick or microscopy /culture
3 glass test : collecting urine at 3 stages during micturition
Renal function test
renal biopsy
imaging studies
cystoscopy / ureteroscopy
what is ultrasound used for?
abscess kidney
Kidney stone
Hydronephrosis
Tumors
bladder / prostate abnormalities
ureter is difficult to visualize –> ureter is retroperitoneal structure deep in the abdomen behind the colon
BUT hydronephrosis is indirect sign of ureter obstruction
what is KUB used for?
detects radio opaque kidney stones
what is IVP used for?
contrast X ray used less frequently due to radiation risk
specially preg women
detects obstruction, stones and tumors
what is CT scan used for ?
Plain CT scan ( non contrast ):
Best for kidney stones
identify renal masses , cysts, trauma
Contrast enhanced CT scan :
Differentiate solid renal tumors from cyst
Renal vascular studies
AVOIDED IN RENAL FAILURE DUE TO RISK OF CONTRAST NEPHROPATHY
CT angiography : Detects vascular causes like AV malformation
what is cystocopy?
Visualization of bladder and urethra using camera
what are the types of CYSTOSCOPY?
Rigid cystoscopy :
Reusable
superior image quality
provide stability for accurate visualtion
better for surgical procedures
HIGH COST
need anathesia
Flexible cystoscopy :
Disposable
Flexible fibers
more comfortable
no need for anesthesia
Lower cost
lower image quality
Less stability
