Hematuria - Tyler Flashcards
macroscopic (gross) hematuria specific laboratory parameters
red sediment with red blood cells on microscopy (>3500 red blood cells per high-power field)
microscopic hematuria specific laboratory parameters
2-3 red blood cells per high-power field on urine microscopy
glomerular cases of hematuria
primary glomerulonephritis, secondary nephritis, or familial
non-glomerular cases of hematuria
lower urinary tract source, or upper urinary tract source
what are the clinical manifestations of renal cell carcinoma?
- *alarm symptoms** (age >40, weight loss, chronic malaise, appetite loss, fever)
- gross hematuria
- flank pain
- solid renal mass on imaging
what are the demographics of renal cell carcinoma?
- male:female 2:1
- cigarette smoker
- familial: von Hippel-Lindau syndrome, hereditary papillary RCC, hereditary leiomyoma-RCC, Birt-Hogg-Dube syndrome
- dialysis-related acquired cystic disease
what are the differential diagnoses of renal cell carcinoma?
- angiomyolipomas (fat density visible by CT)
- renal pelvis urothelial cancers (more central location)
- renal oncocytomas (indistinguishable pre-op)
- renal abscesses
- adrenal tumors
what are the laboratory tests should be run with suspected RCC?
- hematuria (in 60% of cases)
- paraneoplastic syndromes
- erythrocytosis from increased erythropoietin production in 5% (but anemia far more common)
what imaging studies should be preforms with suspected RCC?
- solid renal mass on abdominal US or CT
- CT and MRI scan most valuable (they confirm character of mass, stage the lesion)
- chest radiographs for pulm metastasis
- bone scans for large tumors, bone pain, elevated alkaline phosphatase
what is the expected prognosis of RCC of tumors confined to the renal capsule (T1-2)?
5 year disease-free survivals of 90-100% after radial nephrectomy
what is the prognosis of RCC tumors that extending beyond the renal capsule (T3-4), and node-positive tumors?
50-60% and 0-15% 5 year disease free survival, respectively
what is the prognosis of RCC with solitary resectable metastases?
radical nephrectomy with resection of the metastasis has resulted in 5-year disease-free survival rates of 15-30%
when to refer patients?
- solid renal mass or complex cysts
- RCC
- metastatic disease
- urologist for further evaluation
- urologic surgeon for surgical excision
- oncologist
what are the examples of primary glomerulonephritis that cause hematuria? (3)
- IgA nephropathy
- postinfection glomerulonephritis
- idiopathic glomerulosclerosis
what are the examples of secondary glomerulonephritis? (3)
- SLE
- Wegener’s granulomatosis
- other vasculidities
what are the examples of familial glomerulonephritis?
- thin basement membrane disease
- hereditary nephritis (Alport synd)
What are the clinical manifestation of IgA nephropathy?
- episodic gross hematuria that occurs during upper respiratory infection
What are the clinical manifestation of IgA nephropathy?
- episodic gross hematuria that occurs during upper respiratory infection
- RBC casts with negative serologies for other glomerulonephridities
how is a diagnosis of IgA nephropathy confirmed?
kidney biopsy showing iGa deposits in the mesangium
what does the Oxford IgA nephropathy MEST classification
Messangial hypercellularity
Endocapillary hypercellularity
Segmental glomerulosclerosis
Tubular atrophy/interstitial fibrosis
what is the prognosis of IgA nephropathy?
excellent with normal function and low proteinuria
NOTE: kidney biopsy is restricted to patients with sustained proteinuria .1g/day or worsening kidney function
what lab tests should be run with suspected IgA nephropathy?
- UA (demonstrating protein, RBC, and RBC casts
- serum creatinine may be elevated
- urine protein-tocreatinine ration (reveals mild increases in proteinuria)
- serum IgA (elevated in only 50% of patients, has little clinical utility)
What are the clinical manifestations of medullary sponge kidney?
- present at birht, not diagnosed until fourth or fifth decade
- kidneys have marked irregular enlargement of medullary and interpapillary collecting ducts
- gross or microscopic hematuria
- recurrent UTI’s
- nephrolithiasis (calcium phosphate and calcium oxalate stones)
- decreased urinary concentrating ability and nephrocalcinosis
What are the clinical manifestations of medullary sponge kidney?
- present at birth, not diagnosed until fourth or fifth decade
- kidneys have marked irregular enlargement of medullary and inter-papillary collecting ducts
- gross or microscopic hematuria
- recurrent UTI’s
- nephrolithiasis (calcium phosphate and calcium oxalate stones)
- decreased urinary concentrating ability and nephrocalcinosis
