Hematuria Flashcards
If there is no red sediment but the supernatant is positive for Hgb by urine dipstick, what is that indicative of?
Hemoglobinuria (intravascular hemolysis)
Myoglobinuria (breakdown of skeletal muscle)
- red sediment
- Hgb in the supernatant
+ red supernatant
What disease process?
Beet or blackberry ingestion
Drugs (phenazopyridine, rifampin, phenothiazines, sulfasalazine)
- red sediment
- Hgb in supernatant
+ black or brown supernatant
What are the possible disease processes?
Liver disease
Acute porphyria
Ochronosis
Malignant melanoma
What are risk factors for bladder cancer?
Cigarette smoking
Occupational exposure to chemicals in certain industries (leather, dye, and rubber or tire manufacturing)
Heavy phenacetin use
Past treatment with high doses of cyclophosphamide
Ingestion of aristolochic acid found in some herbal weight-loss preparations
What are hereditary causes of glomerular hematuria?
Thin basement membrane disease
Alport Sydrome
What secondary glomerulonpehritides cause hematuria?
SLE
Wegener’s granulomatosis
Other vasculitides
What primary glomerulonephritides can cause hematuria?
IgA nephropathy
Post-infectious glomerulonephritis
Idiopathic (e.g. focal glomerulosclerosis)
What are some lower urinary tract sources that can lead to hematuria?
Urethritis, prostatitis, BPH, cystitis, bladder carcinoma, prostate carcinoma, exercise-induced
What are some upper urinary tract sources that can lead to hematuria?
Ureteral/renal calculus, hydronephrosis, pyelonephritis, polycystic kidney disease, renal trauma, papillary necrosis, interstitial nephritis (Drug-induced), sickle cell, renal tuberculosis, renal vein thrombosis
What are alarm symptoms associated with hematuria?
Increased age, male, constitutional symptoms, risk factors, and + FHx of deafness or renal disease (e.g. Alport’s Syndrome)
What are essentials of diagnosis for renal cell carcinoma?
Gross or microscopic hematuria, flank pain or mass in some patients, systemic sx such as fever or weight loss, solid renal mass on imaging
What is the difference between renal cell carcinomas and renal pelvis urothelial cancers?
Renal pelvis urothelial cancers are in a more central location, involve the collecting system, and have a positive urinary cytology
What can IgA nephropathy be secondary to?
Hepatic cirrhosis
Celiac disease
HIV infection
Cytomegalovirus
What is a classic presentation for IgA nephropathy?
Episodic gross hematuria that occurs during upper respiratory infections
What do you see on immunofluorescence with IgA nephropathy?
Mesangial IgA and C3 deposits
