Hematuria Cases

Question 1

Cystitis

Answer 1

Generalized infection of the kidneys (usually bacterial)

Presents with:

• painless hematuria
• mild abdominal discomfort with and without palpation
• increased urinalysis frequency/dysuria
• no CVA pain
• minimal to no infectious signs
• NO FEVER

Labs show
- RBCs and WBCs in urine

Treatment = empiric oral antibiotics and get urine culture samples. Adjust antibiotics accordingly once know causative agent is determined.
- follow up with resolution of symptoms, if not resolving recheck UA

Question 2

Pyelonephritis

Answer 2

Looks pretty similar to Cystits except usually presents also with

• flu-like symptoms
• noteworthy CVA tenderness and suprapubic tenderness
• possible GI symptoms (N/V, anorexia, ab pain)
• tachycardia will almost always be present

Lab values

• proteinuria
• WBCs and RBCs
• **bacteria will also be readily present
• **normal platelets and no anemia (rules out HUS)

Treatment:

• admit to the hospital and start empiric IV antibiotics (usually super broad spectrum piperzillin/tazobactum/ceftriaxone/ceftamine)
• adjust antibiotics once culture gets back and also give IV fluids

Question 3

Most common causative agents for acute pyelonephritis

Answer 3

1) E. Coli (80%)
2) klebsiella (5%)
3) staphylococcus saprophyticus (<3%)
4) anything else (1%)

Question 4

What are the signs of acute pyelonephritis that requires hospitalization?

Answer 4

Patient has comorbidities present

They are hemodynamically unstable

Patient is presenting with renal dysfunction or metabolic/respiratory acidosis

Is male

Is pregnant

Looks toxic appearing and/or complains of severe flank/ab pain

Very high fever >103

Cant take liquids by mouth

Question 5

Prostatitis

Answer 5

Generalized bacterial infection of the prostate that causes Hypertrophy of the prostate and sometimes infection of the urinary bladder

Symptoms:

• dysuria and hematuria
• mild lower ab pain/discomfort And may be noted at the base of the penis
• rectal exam will show enlarged prostate
• usually no fever or illness signs (but can still be present)

lab values

• proteinuria and nitrates will be seen in urine
• WBCs/RBCs are seen in urine

Treatment

• start oral antibiotics and get culture (usually start with levofloxacin) usually for 30 days
• adjust antibiotics when lab results come back

Question 6

Risk factors for urinary tract malignancy in patients with microscopic hematuria

Answer 6

microscopic hematuria = no gross hematuria, but dipstick testing shows RBCs in urine

Risk factors:

• analgesic abuse
• exposure to chemicals or dyes occupationally
• history of chronic foreign bodies present
• history of chronic UTIs
• exposure to carcinogenic agents and chemotherapy
• history of gross hematuria
• history of irritative voiding symptoms
• history of pelvic irradiation
• male
• history of past urologic disorder
• older than 35 yrs
• smoking current or past