Hematuria/Dysuria-Leah Flashcards
Blood clots in urine are significant for?
LOWER urinary tract disease
When is it “normal” to see blood in urine?
Lady time
When urine is red/brown, should you be concerned about blood loss?
- No –> color change usually doesn’t = large degree of blood loss
- urinary tract usually not capable of causing significant blood loss
What defines “abnormal microscopic” hematuria?
What about in kids?
More than 2 RBCs/hpf, normally. 5 in kids.
Problem with dipstick testing of urine to detect hematuria?
- frequent false POSITIVES, must do micro eval.
- False negatives aren’t a problems (sensitive test)
Three UA findings that suggest glomerular disease?
- casts
- proteinuria
- dysmorphic cells
(remember, CLOTS rarely come from glomerulus*)
Causes of “isolated” (no renal insufficiency) + “transient” hematuria? (2)
- post infectious GN
- exercise induced hematuria
Causes of isolated/ persistent hematuria? (3)
IgA, Alports, Thin Membrane Lesion
Suspect these if symptoms continue to reoccur over a years time with no kidney insufficiency
When does hematuria require immediate diagnosis?
-It doesn’t, you can repeat exam in a few days to determine persistence
Transient hematuria in patients 50+ should always make you consider?
malignancy
Cancers presenting w/ hematuria?
renal, bladder
rarely: prostate
What cancers can be detected by atypical cells on urine cytology?
- bladder 90% of cases
- upper urinary tract: rarely detectable with cytology
Radiologic exam with the best sensitivity and specificity for masses/ cancers of GU system?
When should is be avoided?
CT urography
-cant use in pregnant women/kids/
Exam that should be done in all adults with unexplained hematuria?
Cystoscopy
Only test that visualizes urethra and prostate?
Cystoscopy
Patients who have normal micro/ radio exams but still have hematuria most likely have?
mild glomerulopathies or intermittent stones
Which gender gets stones most often?
What kind of stones are most common?
Is the prevalence increasing or decreasing?
Male, calcium oxalate, increasing US prevalence (think ^ DM = ^ EDRD = ^PTH = ^stones)
Alkaline urine is assc with what type of stones?
What is the most common cause of these s tones?
struvite –> urease + bugs like Klebsiella, Proteus
Significant risk factor for recurrent stone formation?
Family history
Gold standard for imaging of stones?
Non-contrast helical CT scan (in adults, not kids/preggos)
Nearly 100% specific
Use US in kids/ preggos
When might an abdominal xray be used to dx stones?
-Prior history of radiopaque stones
can miss lucid stones/ other causes
Why is IVP (intravenous pyelogram) no longer used to dx stones?
Lower sensitivity, higher radiation than CT
Tx for kidney stones
pain meds, (opioids can be appropriate), fluids
May also give something to help stone pass (antispasmodic, CCB, etc)
When should kidney stone “be removed”
aka when can’t it pass on its own?
> 10 mm in size, or if persists 4-6 weeks
patients w/ sepsis/ renal failure or other underlying disease may also need immediate removal
