hematuria

Question 1

what can red blood in urine or discoloration of red in urine be associated with

Answer 1

1. foods, like red beats
2. some meds
3. hemorrhagic cystitis
4. severe UTI
5. trauma
6. overwhelming infection
7. bladder ca
8. prostate ca
9. renal ca
10. glomerulonephritis

Question 2

differential dx with hematuria

Answer 2

1. microscopic

2. macroscopic

Question 3

what do all pts need done with hematuria

Answer 3

urine culture, regardless of clinical presentation and symptoms

Question 4

hematuria d/t microscopic qualifies what

Answer 4

> 3 RBCs visualized on 2 separate urine samples

Question 5

microscopic hematuria is visible or non visible

Answer 5

non visible

Question 6

transient causes of microscopic hematuria

Answer 6

UTI 
strenuous activity (marathon runner)

resolves in 48 - 72 hours

Question 7

spurious: contamination, causes of microscopic hematuria

Answer 7

1. menstration

2. intercourse

Question 8

what qualifies true microscopic hematuria

Answer 8

peristence

Question 9

is macroscopic hematuria visible or non visible

Answer 9

visible and it is always pathologic

Question 10

what does macroscopic hematuria look like

Answer 10

red-brown with or w/o clots

Question 11

what do you need to determine with macroscopic hematuria

Answer 11

is it glomerular or non- glomerular

Question 12

differential dx for glomerular macroscopic hematuria

Answer 12

IgA nephropathy
Primary/secondary glomerulonephrotites
Infectious
SLE
Good Pasture
Etc.

Question 13

differential dx for non-glomerular hematuria

Answer 13

Neoplastic
Tubulointerstitial
Vascular
metabolic

Question 14

what distinguishes glomerular and non glomerular

Answer 14

Dysmorphic RBC’s, RBC casts and new or worsening HTN, proteinuria and elevated creatinine

Question 15

Are visible clots d/t glomerular cause

Answer 15

NEVER

they are from lower urinary tract source

Question 16

extrarenal differential dx of hematuria

Answer 16

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

Question 17

ROS for hematuria

Answer 17

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

Question 18

never miss dx for hematuria

Answer 18

bladder cancer
prostate cancer
renal cell cancer

Question 19

physical exam for hematuria

Answer 19

same as for dysuria

inspect external genitalia for obvious lesions or other drainage

male- DRE
female- regular gyn exam

Question 20

diagnostics for microscopic hematuria

Answer 20

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

Question 21

macroscopic diagnostics of hematuria

Answer 21

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