Hematuria Flashcards
Microscopic hematuria
- “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.
Gross/Macroscopic hematuria
- 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.
Causes of false positive dipstick
- Myoglobinuria
- 1-2 RBC/hpf
- Low urine specific gravity causing RBC lysis
- Hemoglobinuria
Causes of false negative dipstick
- High vit. C intake
- Acidic urine
- Concentrated urine
- Proteinuria
Macrohematuria masqueraders
- Drugs
*phenazopyridine (pyridium)
*rifampin
- Myoglobinuria
- Bilirubinuria
- Porphyria
- Menses/vaginal bleeding
- Concentrated urine
- Beets/rhubarb
Sources of hematuria
- Nephrologic
*glomerulous
*nephron
- Urologic
*collecting system
*ureter
*bladder
*prostate
*urethra
Nephrologic/Renal hematuria presentation
- Typically microscopic hematuria
Red blood cell casts on microscopy
- Always pathologic
- Many conditions
*glomerulonephritis
*lupus
*goodpasture’s syndrome
*any renal injury/insult/infarction
Initial hematuria
- The initial stream results in visible blood that transitions to clear urine
- Most commonly urethral source
*stricture
*urethritis
*malignancy (rare)
Terminal hematuria
- The initial stream is clear urine that transitions into visible blood
- bladder trigone
- Bladder neck
*irritated w/ voiding
- Prostate
*BPH
*prostate cancer
Total hematuria
- The entire stream contains visible blood
- Bladder, ureter, renal pelvis
*tumor
*hemorrhagic cystitis
- Prostate
*BPH
*prostate cancer
Upper GU tract organs
- Kidney
- Renal pelvis
- Ureters
Lower GU tract organs
- Bladder
- Prostate
- Urethra
Gold standard of imaging hematuria patients
- CT urogram
CT Urogram
- 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