Hematuria

Question 1

Key history in hematuria

Answer 1

Amount, duration, +/- clots
Other symptoms (constitutional, renal colic, dysuria)
Point along stream (initial vs. terminal vs. throughout)
Medications
History of vigorous exercise
Trauma
Smoking
Stones
Cancer
Easy bleeding
Skin bruising (purpura)

Question 2

Key physical exam in hematuria

Answer 2

Vital signs
Lymph nodes
Abdominal exam
Genitourinary and rectal exams
Extremities

Question 3

65 yo M with painless hematuria
+ heavy smoker
+ works as a painter

Answer 3

Bladder cancer
Renal cell carcinoma
Nephrolithiasis
Prostate cancer

Genitourinary exam, UA, urine cytology, BUN/Cr, PSA, CBC, PT/PTT, cystoscopy, US - renal/bladder, CT - abdomen/pelvis, prostate biopsy

Question 4

35 yo M with painless hematuria

+ FHx of kidney problems

Answer 4

Polycystic kidney disease
Nephrolithiasis
Acute glomerulonephritis (e.g. IgA nephropathy)

Genitourinary exam, UA, urine cytology, BUN/Cr, PSA, CBC, PT/PTT, US - renal, CT - abdomen/pelvis

Question 5

55 yo M with flank pain and blood in urine without dysuria

+ weight loss and fever over last few months

Answer 5

Renal cell carcinoma
Bladder cancer
Nephrolithiasis

Genitourinary exam, UA, urine cytology, BUN/Cr, PSA, CBC, PT/PTT, US - renal, CT - abdomen/pelvis, cystoscopy