Hematuria

Question 1

What is the most common screening test for blood and protein in the urine?

Answer 1

urine dipstick testing

Question 2

How does a dipstick tell if there’s blood in the urine?

Answer 2

It uses hydrogen peroxide, which catalyzes a chemical reaction between hemoglobin (or myoglobin) and the chromogen tetramethylbenzidine

Question 3

A positive urine dipstick roughly corresponds to how many RBCs per high mag field?

Answer 3

2-5 RBCs or more

Question 4

False negative results in a urine dipstick can come from what?

Answer 4

presence of formalin and high ascorbic acid concentration

Question 5

Hematuria is defined as how many RBCs/high power field in adults? Children?

Answer 5

2 RBCs in adults

5 RBCs in chidlren

Question 6

What are the 4 more frequent causes of hematuria?

Answer 6

1. transient/unexplained
2. UTI
3. stones
4. Cancers (bladder, kidney, prostate)

Question 7

What are some less common causes of hematuria?

Answer 7

exercise
trauma
endometriosis
sickle cell disease
polycystic kidney disease
glomerular disease

Question 8

What are the risk factors for urinary tract malginancy?

Answer 8

1. age over 35
2. smoking hx
3. occupational exposure to chemicals
4. hx of hematuria, chronic cystitic
5. pelvic irradiation
6. exposure to cyclophosphamide
7. hx of indwelling foreign body
8. analgesic abuse
9. history of obestiy
10. hx of HTN

Question 9

How does spinning red urine down help with diagnosis?

Answer 9

if the urine sediment is red = hematuria

if the supernatant is red = NOT hematuria

Question 10

What’s the next step if the supernatant is red then?

Answer 10

dipstick for heme

Question 11

If the dipstick is negative for heme, what are the three possibilities?

Answer 11

porphyria
phenazopyridine (azo)
beets

Question 12

What’s the red color from in beeturia?

Answer 12

betalaine

Question 13

Beeturia will more predictably occur in what patients?

Answer 13

those with iron deficiency
achlorhydric (pernicious anemia)
diet rich in oxalate containing foods

Question 14

If the red supernatant dipstick is positive for heme, what are the two possibilities?

Answer 14

heymoglobinuria or myoglobinuria

Question 15

How do you determine if a patient has hemoglobinuria or myoglobinuria?

Answer 15

take a blood sample and centrifuge it down

if the plasma is clear, it’s myoglobinuria
If the plasma is red, it’s hemoglobinuria

Question 16

IF the hematuria presents with concurrent pyruai and dysuria, what is it?

Answer 16

probalby UTI

Question 17

If the hematuria presents after a recent upper respiratory infection?

Answer 17

post-infectious glomerulonephritis

Question 18

If the hematuri presents witha family history of renal failure?

Answer 18

think alport syndrome or thin basement membrane disease

Question 19

If the hematuria presents with unilateral flank pain?

Answer 19

kidney stone

Question 20

If the hematuria presents with symptoms of hesitancy and dribbling in a man?

Answer 20

prostatism

Question 21

IF the hematuria presents with cyclic hematuria in women?

Answer 21

endometriosis

Question 22

What are some ways you can differentiate glomerular bleeding from extraglomerular bleeding?

Answer 22

1. RBC casts are pathogonomic for glomerular bleeding
2. with proteinuria comes form the glomerulus
3. dysmorphic appearing RBCs come from a glomerular source - damaged as they go through the tubules
4. smokey brown or coca cola urine is from glomeulus
5. clots are NEVER from the glomerulus

Question 23

What are some radiological tests for hematuria?

Answer 23

CT scan of abd and pelvis
cytoscopy to see bladder
ultrasound for repeats
retrograde pyelography for ureters
urinary cytology for cancers
angiography for unexplained bleeding

Question 24

What are some vasculature abnormalities that can cause hematuria?

Answer 24

arterio-venous malformations

fistulas

Question 25

What syndrome should you consider if the patient has hematuria and flank pain but you rule out infection and stones?

What’s abnormal?

Answer 25

loin pain-hematuria syndrome

the GBM is abnormal and there’s possibly an association with intratubular crystal formation without actual stone formation

Question 26

What are the three most common causes of persistent microscopic hematuria in chidlren?

Answer 26

glomerulopathies (IgA nephropathy, Alpor’sts, Thin basement membrane disease, post-infectious)

hypercalciuria

nutcracker syndrome (left renal vein compression by aorta and superior mesenteric artery - Japanese kids)

Question 27

What should be the evaluation of microscopic hematuria in children if asympomatic with no protien? With proeinturia?

Answer 27

without: just observe
with: do a 1st void morning specimen for urine total protein/creatinine ratio and measure serum creatinine. nephrology consult if abnormal