Hematuria

Question 1

What key history would you obtain from a patient who complains of hematuria?

Answer 1

Amount
Duration
Clots?
Associated symptoms (consitutional, renal, colic, dysuria, irritative voiding symptoms)
Medications
History of vigorous exercise, truama, smoking, stones, cancer, easy bleeding

Question 2

What key physical exams would you perform for a patient who complains of hematuria?

Answer 2

Vital signs
Lymph nodes
Abdominal exam
Genitourinary and rectal exams
Extremities

Question 3

65 yo M presents with painless hematuria. He is a heavy smoker and works as a painter. Differentials?

Answer 3

Bladder cancer
Renal cell carcinoma
Nephrolithiasis
Acute glomerulonephritis
Prostate cancer
Coagulation disorder (i.e. factor VII antibody)
Polycystic kidney disease

Question 4

65 yo M presents with painless hematuria. He is a heavy smoker and works as a painter. Differentials: bladder cancer, renal cell carcinoma, nephrolithiasis, acute glomerulonephritis, prostate cancer, coagulation disorder (i.e. factor VII antibody), polycystic kidney disease. Workup?

Answer 4

Genitourinary exam
UA, urine cytology
BUN/Cr
PSA
CBC
PT/PTT
Cystoscopy
U/S - renal/bladder
CT - abdominal/pelvis
IVP

Question 5

35 yo M presents with painless hematuria. He has a family history of kidney problems. Differentials?

Answer 5

Polycystic kidney disease
Nephrolithiasis
Acute glomerulonephritis (e.g. IgA nephropathy)
UTI
Coagulation disorder
Bladder cancer

Question 6

35 yo M presents with painless hematuria. He has a family history of kidney problems. Differentials: polycystic kidney disease, nephrolithiasis, acute glomerulonephritis (e.g. IgA nephropathy), UTI, coagulation disorder, bladder cancer. Workup?

Answer 6

Genitourinary exam
UA
BUN/Cr
PSA
CBC
PT/PTT
U/S - renal
CT - abdominal/pelvis
IVP

Question 7

55 yo M presents with flank pain and blood in his urine without dysuria. He has experienced weight loss and fever over the past two months. Differentials?

Answer 7

Renal cell carcinoma
Bladder cancer
Nephrolithiasis
Acute glomerulonephritis
Pyelonephritis
Prostate cancer

Question 8

55 yo M presents with flank pain and blood in his urine without dysuria. He has experienced weight loss and fever over the past two months. Differentials: renal cell carcinoma, bladder cancer, nephrolithiasis, acute glomerulonephritis, pyelonephritis, prostate cancer. Workup?

Answer 8

Genitourinary, rectal exam
UA, urine cytology
BUN/Cr
PSA
CBC
PT/PTT
U/S - renal
CT - abdomen/pelvis
Intravenous pyleogram (IVP)