hematuria Flashcards
what can red blood in urine or discoloration of red in urine be associated with
- foods, like red beats
- some meds
- hemorrhagic cystitis
- severe UTI
- trauma
- overwhelming infection
- bladder ca
- prostate ca
- renal ca
- glomerulonephritis
differential dx with hematuria
- microscopic
2. macroscopic
what do all pts need done with hematuria
urine culture, regardless of clinical presentation and symptoms
hematuria d/t microscopic qualifies what
> 3 RBCs visualized on 2 separate urine samples
microscopic hematuria is visible or non visible
non visible
transient causes of microscopic hematuria
UTI strenuous activity (marathon runner)
resolves in 48 - 72 hours
spurious: contamination, causes of microscopic hematuria
- menstration
2. intercourse
what qualifies true microscopic hematuria
peristence
is macroscopic hematuria visible or non visible
visible and it is always pathologic
what does macroscopic hematuria look like
red-brown with or w/o clots
what do you need to determine with macroscopic hematuria
is it glomerular or non- glomerular
differential dx for glomerular macroscopic hematuria
IgA nephropathy Primary/secondary glomerulonephrotites Infectious SLE Good Pasture Etc.
differential dx for non-glomerular hematuria
Neoplastic
Tubulointerstitial
Vascular
metabolic
what distinguishes glomerular and non glomerular
Dysmorphic RBC’s, RBC casts and new or worsening HTN, proteinuria and elevated creatinine
Are visible clots d/t glomerular cause
NEVER
they are from lower urinary tract source
extrarenal differential dx of hematuria
Ureter Infectious, stone, stricture Bladder Cancer, infectious, stone Urethra Infection, trauma, stricture As stone is passing it can cause tears Prostate BPH, cancer, prostatitis, trauma
ROS for hematuria
number of episodes and duration of symptoms
Color description
Bright red hemorrhaging color, pink, frothy, rusty colored brown
Clots/no clots pivotal point
Pain (painless=bladder cancer 85% of the time)
Questions that guide r/o stones versus infection versus tumors
Trauma (foley, procedure in male or female)
Are they able to urinate? How much can they urinate? Clue for prostatitis
Menses
Dysuria
Look at diseases that can affect the kidney PMH HTN, h/o CKD, autoimmune FH cancer,
Smoking history (increases risk of bladder, renal, and prostate CA)
Recent foods eaten
Beets for example turn urine red
Change in medication
never miss dx for hematuria
bladder cancer
prostate cancer
renal cell cancer
physical exam for hematuria
same as for dysuria
inspect external genitalia for obvious lesions or other drainage
male- DRE
female- regular gyn exam
diagnostics for microscopic hematuria
Urine culture Positive treat repeat Negative or persistent BP BUN/Creatinine/GFR Urine protein Red cell casts All Normal Nonglomerular non visible hematuria Sx versus non sx directs further care
macroscopic diagnostics of hematuria
Blood clots UA and cystoscopy Looking for stones Non contrast CT Cystoscopy No clots UA \+RBC/protein culture Likely CT etc. will send out to urologist
