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CRRAB II > Hematuria > Flashcards

Hematuria Flashcards

1
Q

Urine dipstick testing

A
  • -Most common test for blood and protein in urine.
  • -Utilizes hydrogen peroxide which catalyzes chemical reaction.
  • -Roughly corresponds to 2-5 RBCs per high power field
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2
Q

False negative and positive results on urine dipstick testing

A
  • Negative: formalin and high urinary concen. of ascorbic acid can cause
  • Positive: alkaline urine (>9) or contamination with oxidizing agents used to clean perineum
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3
Q

Hematuria (microscopic exam findings)

A

2 RBCs/high power field in adults

5 RBCs/high power field in children

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4
Q

Common causes of hematuria

A
  • -Transient, unexplained
  • -UTI
  • -Stones
  • -Cancer: bladder, kidney, prostate
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5
Q

Other causes of hematuria

A

Exercise, trauma, endometriosis, sickle cell, polycystic kidney disease, glomerular disease

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6
Q

Risk factors for urinary tract malignancy

A
  • -Older than 35
  • -Smoking history
  • -Occupational exposure
  • -Hx of gross hematuria, chronic cystitis, pelvic irradiation, exposure to cyclophosphamide, chronic indwelling of foreign body, obesity, analgesic abuse, HTN
  • -Alcohol use may be protective
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7
Q

What if urine sediment is red when sample spun?

A

Hematuria

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8
Q

What if the supernatant is red when sample spun?

A

Not hematuria. Check for heme

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9
Q

What if dipstick with red supernatant is negative for heme as well?

A

Think about porphyria, phenazopyridine, BEETS (from betalaine pigment)

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10
Q

What if the red supernatant is + for heme?

A

Myoglobinuria (plasma clear) or hemoglobinuria (plasma red)

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11
Q

Clues to diagnosis of hematuria

A
  • -Concurrent pyuria and dysuria
  • -Recent URI
  • -FHx of renal failure
  • -Unilateral flank pain w/radiation to groin
  • -Symptoms of hesitancy and dribbling
  • -Vigorous exercise/trauma
  • -Cyclic hematuria in women
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12
Q

What signs indicate glomerular bleeding?

A
  • -Red cell casts
  • -Proteinuria (if large amounts)
  • -Dysmorphic appearing red cells
  • -Smokey brown or “coca cola” color
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13
Q

What signs indicate extraglomerular bleeding?

A

Clots

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14
Q

Tests for hematuria

A
  • -CT scan of abdomen and pelvis
  • Cystpscpy
  • -US
  • -Retrograde pyelography
  • -Urinary cytology
  • -Angiography (usually for therapeutic reasons)
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15
Q

What percentage of cases of unexplained hematuria are due to underlying glomerular disease?

A

50%

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16
Q

Microscopic hematuria in children (pop. studies)

A

3-4% have + dipstick for blood, 1% after 2nd UA

17
Q

Most common causes of microscopic hematuria in children that is persistent

A
  • -Glomerulopathies (IgA nephropathy, Alport’s syndrome, thin basement membrane disease, post-infectious glomerulonephritis
  • -Hypercalciuria
  • -Nutcracker syndrome
18
Q

Nutcracker syndrome

A

L renal vein comprssion by the aorta and superior mesenteric artery. Increased venous pressure and hematuria based on this.

19
Q

Eval of asymptomatic microscopic hematuria in children

A
  • -Asymptomatic w/o protein: benign/observe
  • -Asymptomatic w/proteinuria: 1st void morning speciment to quantitate total protein/creatinine ratio and measure serum creatinine, consider nephrology referral if either abnormal
20
Q

Causes of symptomatic hematuria in children

A
  • -Glomerular diseases
  • -Interstitial/tubular disease
  • -Lower UT cause
  • -Nephrolithiasis
  • -Tumor
  • -Vascular disease
  • -Gross hematuria: UTI, trauma
21
Q

Urolithiasis Epidemiology

A

12% men and 5% women will develop symptomatic stone by age 70. Rate of occurrence increases with age. Whites > blacks, 7-10/1000 hospital admissions

22
Q

Urolithiasis etiology

A
  • -80% calcium
  • -Oxalate > phosphate
  • -Remainder uric acid, struvite, or cysteine stones
23
Q

Urolithiasis symptoms

A
  • Flank pain
  • Abdominal pain
  • Testicle/labial pain
  • Pain tends to wax/wane
  • Gross/microscopic hematuria
  • Possible N & V, dysuria, urgency
24
Q

Diagnosis of urolithiasis

A
  • X ray (more so to follow up)
  • US (if recurrent stones)
  • CT (most common, esp. in ER setting)
25
Q

Treatment of urolithiasis

A
  • Pain meds
  • Hydration
  • Ureteroscopy
  • Lithotripsy
  • Pyelolithotomy
  • Percutaneous nephrolithotomy
26
Q

Calcium oxalate/calcium phosphate stones risk factors

A
  • -Increased Ca++ excretion
  • -Increased uric acid excretion
  • -Reduced citrate excretion
  • -Low urine vol.
  • -Increased oxalate excretion
27
Q

Medical problems associated with Ca++ stone formation

A
  • -Primary hyperparathyroidism
  • -Medullary sponge kidney
  • -Distal renal tubular acidosis
28
Q

Causes of Idiopathic hypercalciuria

A
  • -Absorptive hypercalciuria
  • -Fasting hypercalciuria (bone loss)
  • -Renal hypercalciuria (renal leak)
29
Q

Hypocitraturia causes

A
  • -Chronic diarrhea
  • -Renal tubular acidosis
  • -Ureteral diversion
  • -High protein diet
  • -Topiramate
30
Q

Hyperoxaluria causes

A
  • -Diet 10%, Glycine metabolism 40%, ascorbic acid metabolism 40%.
  • -Increased oxalate absorption (low Ca++ diet, absorptive hypercalciuria, enteric hyperoxaluria)
  • -Overproduction of oxalate
31
Q

Metabolic work-up for Ca++ stone formation

A
  • -Measure plasma Ca++ concen.
  • -Parathyroid hormone
  • -Electrolytes
  • -Serum uric acid
  • -24 hr urine collection (for vol, Ca++, uric acid, citrate, oxalate, creatinine, pH, Na+, PO4-

CRRAB II (13 decks)

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