Hematuria DSA Flashcards
Gross hematuria is defined as what?
Presence of blood that is visible to the naked eye (>3500 RBC per high-power field)
Microscopic hematuria is defined as what?
2-3 RBC per high field on urine microscopy
ALL patients with hematuria should have a ___________, regardless if there is liklihood of infection.
urine culture
Dx gross (macroscopic) hematuria
- Patient presents with red/brown urine (sometimes w clots)
- Dx of gross hematuria is confirmed by centrifuging the urine specimen
- UNLESS, symptoms are highly suggestive
Dx microscopic hematuria
- Perform a careful history (often, pt comes in for UTI treatment or routine UA)
- Conduct urine dipstick test
- Several days later, repeat urine dipstick test
-
Microscopic examination of urine
1. (+): at least 2 properly collected urine specimens show >3 RBC/high-powered field (hpf)
2. (-): No RBCs; consider hemoglobinuria or myoglobinuria
-
Microscopic examination of urine
Dx macroscopic/gross hematuria
Is microscopic hematuria noticed by the patient?
No.
It is diagnosed on UA after treatment for UTI or a routine UA.
Prevelance of microscopic hematuria
High in older people
High in women
Prevelance of a serious disease (cancer) is higher in patients with ______ hematuria, however _____ hematuria can also indicate significant GU pathology.
Gross
Microscopic
Non-glomerular microscopic hematuria can be indicative of what?
Bladder cancer
What are risk factors for bladder cancer?
- Smoking
- Aniline dyes in leather, tire and rubber factories
- Heavy phenacetin use
- Past use of high doses of cyclophosphamide
- Herbal weight-loss preps with aristolochic acid found in
All patients with a single episode of gross hematuria need what?
- Thorough H & P
- Urologic or nephrologic evaluation
* Unless a self-limited transient cause is found (trauma, infection, menses, exercise-induced).- However, even if the patient has transient causes, if significant risk factors for maligancy are found, eval further.
- Urologic or nephrologic evaluation
Is one episode of microscopic hematuria less serious than recurrent episodes?
NO.
Hematuria in patients receiving anticoagulation therapy should/should not be solely attributed to anticoagulant.
Should not
Blood in the urine can be an ____ and cause _____, even without a UTI or kidney stones.
irritant
dysuria
Because ____ men with microscopic/gross hematuria are more likely to have a GU malignancy, we should evaluate for it even in the prescense of what ?
Older men
Symptoms of BPH (nocturia, polyuria and decreased force of urinary stream)
What can help us define a patients diagnosis more accuretely and why?
Determining glomerular vs. non-glomerular causes of hematuria, because there is alot of overlap in microscopic and gross hematuria.
What are alarm symptoms associated with hematuria?
-
Increased age (>40-50); Males
- increased risk of neoplasm (cancer)
-
Constituional symptoms (WL, loss of appetite, chronic malaise, fatigue)
- Cancer or infection
-
Personal and social history factors that increase risk of cancer
- Smoking
- Aniline dyes in leather, tire and rubber factories
- Cyclophosphamide
- Pelvic irradiation
- WL herbal preparations that contain aristolochoic acid
- family history of deafness or renal disease
- Alport syndrome, a familial diseaes
___________ hematuria is always pathologic.
True macroscopic hematuria
Microscopic (nonvisible) hematuria can be ______, ______ or _____.
Transient, spurious, persistant
What are the differences between the transient and spurious causes of microscopic hematuria?
-
Transient causes: UTIs (which can also cause macroscopic) and strenous exercise
- Hematuria goes away on repeat testing 48 hours later or after not exercising for 72 hours.
- Spurious causes: urinary contamination from mentstruation and sexual intercourse
DDx of hematuria is divided into what?
1. Microscopic hematuria
2. Macroscopic hematuria
If there is considerable overlap in the causes of microscopic and macroscopic hematuria, it may be most pracitical to consider what?
If the hematuria is glomerular in origin.
How can we distinguish if hematuria is glomerular/non-glomerular in origin?
- Dysmoprhic RBC (acanthocytes)
- Red cell casts
- New or acutely worsening HTN or proteinuria
- Increased creatnine.
THESE ARE NOT found when hematuria is d/t renal structural abnormality or abnormality distal to kidneys.