Hematuria ~ Tyler Flashcards
Distinguish between macroscopic (gross) hematuria and microscopic hematuria relating specific laboratory parameters in defining each.
Risk factors for bladder cancer include…
Risk factors for bladder cancer include cigarette smoking, occupational exposure to chemicals used in certain industries (leather, dye, and rubber or tire manufacturing), heavy phenacetin use, past treatment with high doses of cyclophosphamide, and ingestion of aristolochic acid found in some herbal weight-loss preparations.
All patients with even a single episode of gross hematuria should receive a thorough history and physical examination followed by urologic or nephrologic evaluation unless a self-limited, transient cause is identified (e.g. trauma, infection, menses, exercise induced). Even in patients with transient causes, if there are significant risk factors for malignancy (see Alarm Features), further evaluation should be considered. A careful history should also be performed in all patients with microscopic hematuria. Most experts recommend additional evaluation only if one or more repeated urinalyses confirm microscopic hematuria. However, there is no evidence to suggest that an isolated episode is less serious than recurrent episodes. Thus, some authors recommend that unless a self-limited cause is found, a complete evaluation should be undertaken, especially in men over the age of 40 and those with risk factors for significant disease (Figure 2).
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What are the alarm symptoms associated with hematuria?
Alarm Symptoms associated with Hematuria: • Increased age (particularly age older than 40–50 years) and male sex are associated with an increased incidence of neoplasm. • Constitutional symptoms (weight loss, appetite loss, chronic malaise, or fatigue) suggest malignancy or chronic infection. • A variety of factors in the personal and social history may increase the likelihood of a malignancy, including a heavy smoking history, exposure to aniline dyes in leather, tire, or rubber manufacturing industries; previous treatment with cyclophosphamide or pelvic irradiation; and ingestion of herbal weight loss preparations containing aristolochic acid. • A positive family history of deafness or renal disease suggests familial disease, e.g. Alport syndrome
• Hematuria in patients receiving anticoagulation therapy should not be attributed solely to the anticoagulant. • Blood in the urine can be an irritant and may cause dysuria, even in the absence of urinary tract infection or kidney stone disease. • Because older men with microscopic or gross hematuria are more likely to have a genitourinary malignancy, diagnostic evaluation should be pursued even in the presence of nocturia, polyuria, and decreased force of urinary stream (symptoms suggestive of benign prostatic hypertrophy). • Given significant overlap in microscopic and gross hematuria, it is suggested that adding an approach to determining glomerular versus non-glomerular causes of hematuria is important to help define a patient’s diagnosis more accurately.
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Identify glomerular causes of hematuria.
Identify non-glomerular causes of hematuria.
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What are the pivotal points that help distinguish glomerular hematuria from non-glomerular hematuria?
Pivotal points that help distinguish glomerular hematuria from non-glomerular hematuria include dysmorphic RBCs (acanthocytes), red cell casts, new or acutely worsening hypertension or proteinuria, and increased creatinine. while these abnormalities may also be seen in some of the interstitial and vascular causes of hematuria, they will not be found when hematuria is caused by a renal structural abnormality or an abnormality distal to the kidneys.
Visible blood clots, which are never due to a ______ cause, are another pivotal point, indicating a what kind of source?
Visible blood clots, which are never due to a glomerular cause, are another pivotal point, indicating a lower urinary tract source of the hematuria.
What are the essentials of diagnosis for RCC?
• Essentials of Diagnosis o Gross or microscopic hematuria o Flank pain or mass in some patients o Systemic symptoms such as fever, weight loss may be prominent o Solid renal mass on imaging
what are the familial dz associations of RCC?
o Familial: von Hippel-Lindau syndrome, hereditary papillary renal cell carcinoma, hereditary leiomyoma-renal cell carcinoma, Birt-Hogg-Dube syndrome o Association: dialysis-related acquired cystic disease
Sx and signs of RCC?
• Symptoms and Signs o Hematuria (gross or microscopic) in 60% of cases o Flank pain or an abdominal mass in ~30% o Triad of flank pain, hematuria, and mass in ~10–15%, often a sign of advanced disease o Fever occurs as a paraneoplastic symptom o Symptoms of metastatic disease (cough, bone pain) in ~20–30% at presentation o Often detected incidentally
DDx of RCC?
o Angiomyolipomas (fat density usually visible by CT) o Renal pelvis urothelial cancers (more central location, involvement of the collecting system, positive urinary cytology) o Renal oncocytomas (indistinguishable from renal cell carcinoma preoperatively) o Renal abscesses o Adrenal tumors, certain types
What type of imaging is needed to dx RCC?
o Solid renal masses on abdominal ultrasonography or CT o CT and MRI scanning are the most valuable imaging tests; they confirm character of the mass, stage the lesion o Chest radiographs for pulmonary metastases o Bone scans for large tumors, bone pain, elevated alkaline phosphatase levels o MRI and duplex Doppler ultrasonography can assess for the presence and extent of tumor thrombus within the renal vein or vena cava in selected patients
In regards to RCC, what are the most valuable imaging tests; they confirm character of the mass, stage the lesion?
CT and MRI scanning are the most valuable imaging tests; they confirm character of the mass, stage the lesion
