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RGU Exam 3 > Hematuria > Flashcards

Hematuria Flashcards

1
Q

Microscopic hematuria

A
  • “Microhematuria”
  • >3 RBCs per HPF on microscopy w/ centrifuged sample
  • Any single urinalysis w/ >3 RBC/hpf must be evaluated
  • Urine dipstick is not sufficient to diagnose microscopic hematuria
  • 4% of pts w/ microscopic hematuria will be found to have urologic malignancy

*follow-up eval will reveal malignancy in up to 3% of initially neg. pts.

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2
Q

Gross/Macroscopic hematuria

A
  • Visible blood in the urine
  • Any episode of grossly visible blood in the urine must be evaluated
  • “Macrohematuria”
  • 23% of pts w/ gross hematuria may be found to have a urologic malignancy

*follow-up eval will reveal malignancy in up to 18% of initially neg. pts.

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3
Q

Causes of false positive dipstick

A
  • Myoglobinuria
  • 1-2 RBC/hpf
  • Low urine specific gravity causing RBC lysis
  • Hemoglobinuria
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4
Q

Causes of false negative dipstick

A
  • High vit. C intake
  • Acidic urine
  • Concentrated urine
  • Proteinuria
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5
Q

Macrohematuria masqueraders

A
  • Drugs

*phenazopyridine (pyridium)

*rifampin

  • Myoglobinuria
  • Bilirubinuria
  • Porphyria
  • Menses/vaginal bleeding
  • Concentrated urine
  • Beets/rhubarb
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6
Q

Sources of hematuria

A
  • Nephrologic

*glomerulous

*nephron

  • Urologic

*collecting system

*ureter

*bladder

*prostate

*urethra

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7
Q

Nephrologic/Renal hematuria presentation

A
  • Typically microscopic hematuria
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8
Q

Red blood cell casts on microscopy

A
  • Always pathologic
  • Many conditions

*glomerulonephritis

*lupus

*goodpasture’s syndrome

*any renal injury/insult/infarction

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9
Q

Initial hematuria

A
  • The initial stream results in visible blood that transitions to clear urine
  • Most commonly urethral source

*stricture

*urethritis

*malignancy (rare)

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10
Q

Terminal hematuria

A
  • The initial stream is clear urine that transitions into visible blood
  • bladder trigone
  • Bladder neck

*irritated w/ voiding

  • Prostate

*BPH

*prostate cancer

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11
Q

Total hematuria

A
  • The entire stream contains visible blood
  • Bladder, ureter, renal pelvis

*tumor

*hemorrhagic cystitis

  • Prostate

*BPH

*prostate cancer

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12
Q

Upper GU tract organs

A
  • Kidney
  • Renal pelvis
  • Ureters
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13
Q

Lower GU tract organs

A
  • Bladder
  • Prostate
  • Urethra
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14
Q

Gold standard of imaging hematuria patients

A
  • CT urogram
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15
Q

CT Urogram

A
  • CT w/ and w/o IV contrast, w/ delayed imaging opacifying the renal pellvis, ureters and bladder
  • Obviates the neeed for retrograde pyelograms
  • Gold standard test
  • Avoid in renal pts due to IV contrast
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16
Q

Renal/Bladder Ultrasound

A
  • May not differentiate less obvious renal lesion
  • Requires retrograde pyelograms to complete workup
17
Q

Workup of hematuria patient

A
  • History and physical

*DRE in males

*bimanual exam in females

  • Urinalysis/Urine culture

*pos. dipstick must be ruled out w/ 3 additional microscopic urinalyses

  • Urine cytology

*symptomatic microhematuria, persistent microhematuria, gross hematuria

  • Lab eval

*CBC; hemoglobin, WBC, platelet count

  • Coags

*PT, PTT, INR

  • Chemistry

*creatinine

*BUN

  • PSA

*in the appropriate pt.

18
Q

Cystoscopy evaluation required for

A
  • Gross hematuria
  • Microscopic hematuria >35
  • Microscopic hematuria <35 if risk factors or persistent
19
Q

Ureteroscopy evaluation required for

A
  • If blood seen emanating from ureteral orifice on cystoscopy or pos. cytology w/ neg. cystoscopy, or pos. CTUrogram/retrograde pyelograms
  • Selective cytology
20
Q

Prostatic hematuria treatment

A
  • Endoscopic resection (TURP)
  • 5alpha-reductase inhibitors
21
Q

Hemorrhagic cystitis

A
  • Diffuse inflammation and bleeding from bladder mucosa
  • Infectious causes

*BK virus in immunocompromised

*adenovirus

  • Post radiation
  • Chemical
  • Cyclophosphamide (prevent w/ mesna)
  • Numerous others, less common
22
Q

Refractory hemorrhagic cystitis treatment

A
  • Hyperbaric oxygen therapy
  • Aminocaproic acid
  • Formalin
  • 1% Alum
23
Q

Hyperbaric oxygen therapy

A
  • Used to treat recurrent hemorrhagic cystitis
  • Enhanced angiogenesis, vasoconstriction, immune function
24
Q

Aminocaproic acid

A
  • Used to treat recurrent hemorrhagic cystitis
  • Inhibits plasmin/clot lysis
  • IV, PO, or intravesical
  • Prothrombotic
25
Q

Formalin

A
  • Used to treat recurrent hemorrhagic cystitis
  • Coagulates protein/scars bladder
  • Cannot be given if vesicoureteral reflux or extravasation from bladder
  • Requires general anesthesia
26
Q

1% Alum

A
  • Used to treat recurrent hemorrhagic cystitis
  • Protein precipitates over bleeding
  • Can be given if reflux

RGU Exam 3 (19 decks)

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