Hematuria Flashcards
Hematuria differential
coagulation studies,
glomerular disease, - no clots
sickle cell trait,
bladder cancer or renal cell cancers
kidney stones
sickle trait pts can have hematuria because of
papillary necrosis and renal papillary infarction becasue the natural renal papilla is in a hypoxic and hypertonic environment with slow papillary blood velocity that can predispose itself to sickling of RBCs and cause hypoxia.
Best way to tell if pt has hematuria due to sickle cell trait
needs a Hgb electrophoresis and confirm diagnosis
which cancer is sickle cell trait predisposed to getting?
renal medullary carcinoma
Anyone with hematuria must order
urinalysis - make sure not active sediment - if present consider glomerular disease or dismorphic RBCs must also order a U/S of renal area to make sure no signs of abnormal anatomy
When to get renal biopsy for hematuria?
if suspecting glomerular disease and see signs of active urine sediment and dysmorphic red blood cells, red blood cell casts, significant proteinuria and reduced GFR
microscopic hematuria is defined by:
RBCs>3/hpf
Risk factors for cancer:
age, gender, ethnicity and cigarette smoking history and possible exposure to chemicals associated with bladder cancer
chemicals associated with bladder cancer are:
aromatic amine dyes, arsenic and chemicals involved in manufacture of dyes, rubber, leather, and textiles.
algorithm for evaluation of hematuria
is hematuria common with patients who are on DAPT?
no it’s not common. Hematuria likely related to GU tract abnormalities.
needs UA and if bland (no protein unlikely glomerular dx) ,needs to get a CT urography and cystoscopy to rule out underlying malignancy
Do pts on DAPT for CAD need to stop DAPT prior to getting a cystoscopy for evaluation of hematuria
no. continue DAPT.
Cystoscopy is a minimally invasive procedure and they may have minor spotting after the procedure.
positive cytology test - positive for malignancy
positive for gross hematuria
CT and cystocopy don’t show any masses
what to do next?
if suspecting bladder cancer but CT and cystoscopy don’t show any signs of masses, majority of urothelial carcinomas are the bladder so next best step is to do:
random biopsies of the bladder to evaluate for positive cytology and occult tumor. May see infiltrative carcinomas.
don’t get IV pyelogram because less sensitive than a CT scan.
mean age of bladder cancer?
69 yrs and associated with smoking and azo-dyes
see intermittent dysuria, hematuria, and perineal pain that can be mistaken for kidney stone or UTI.
IgA nephropathy classically presents as
young person
recurrent gross hematuria within days or while having an URI or physical exertion
has benign course. No renal insufficiency
NOT the same as post infectious glomerulonephritis from Strep because that’s happens about 2-3 weeks later.
