Hematuria Flashcards
How do you distinguish between extraglomerular and glomerular hematuria using protein levels in the urine?
- extraglomerular = <500 mg/day
- glomerular = >500 mg/day
The results of the centrifuged urine shows a supernatant red. You perform a dipstick heme and it comes back negative. What are the 4 possible causes of this?
supernatant = means when you spin but the particles do not drop to the bottom.
- Beeturia
- Phenazopyridine (Pyridium)
- Porphyria
- Other (Rifampin)
What is the most common cause of hematuria in a patient <40 yo?
GU infection
How do you distinguish between extraglomerular and glomerular hematuria using color?
- extraglomerular = red or pink
- glomerular = red, brown, “coca-cola”
If a pregnant patient presents with gross hematuria and without visible clots what imaging study is recommended?
-renal and bladder u/s
If you are concerned for a bladder tumor what imaging study should you order?
cystoscopy
If a non-pregnant patient presents with gross hematuria and WITHOUT visible clots what imaging study is recommended? (2)
- CTU
- Cystoscopy
What is the imaging test of choice for hematuria?
Ultrasound
What is the best test to evaluate for bladder or ureteral cancer?
Cystoscopy
If a patient presents with gross hematuria and visible clots what should you do?
- Order a CTU w + w/o contrast
- Refer for urgent urology evaluation
If the patient is over 40 and presents with hematuria what 3 tests do you want to order?
- Cystoscopy
- IVP
- Urine cytology
What diagnostic test uses contrast dye and can lead to ATN.
IVP
The results of the centrifuged urine shows a supernatant red. What test should you do next?
Dipstick heme
What is the most common cause of microscopic hematuria?
BPH
The results of the centrifuged urine shows a supernatant red. You perform a dipstick heme and it comes back positive. You look at the plasma color next. What is the diagnosis if it comes back clear vs red?
- clear = myoglobinuria
- red = hemoglobinuria
If a male or child presents with UTI symptoms what should you do?
-full urological workup
If a patient presents with red or brown urine what is the best lab test to order?
centrifuge
If you are considering trauma to the kidneys what test do you want to order?
CT/CT angio of the kidneys
The results of the centrifuged urine shows a supernatant red. You perform a dipstick heme and it comes back positive. What do you do next?
Look at the plasma color
What are the 2 most common cause of hematuria in a patient >40 yo?
- Cancer
- prostatic disease
The results of the centrifuged urine shows a supernatant red. You perform a dipstick heme and it comes back positive. What are the 2 possible causes?
- myoglobinuria
- hemoglobinuria
What drugs might cause pseudohematuria? (3)
- Ibuprofen
- Phenazopyridine (Pyridium)
- Rifampin
How can you tell the difference between hematuria in the upper vs lower GU tract?
- upper GU = terminal hematuria
- lower GU = hematuria throughout micturition
Myoglobinuria can lead to what form of AKI?
ATN
