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Med School Year 3 > Urology - Haematuria > Flashcards

Urology - Haematuria Flashcards

1
Q

list 10 causes of haematuria:

A
  • UTI
  • renal cancer
  • bladder cancer
  • prostate cancer
  • BPH
  • glomerulonephritis
  • thin basement membrane disease
  • haemolytic uraemic syndrome
  • renal calculi
  • schistosomiasis
  • trauma - eg catheter insertion
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2
Q

what % of pts with visible haematuria have an underlying malignancy?

A

14%

% is less in pts under 45

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3
Q

what % of patients with non-visible haematuria have an underlying malignancy?

A

3%

% is less in pts under 45

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4
Q

what are the two main subsections in the aetiology of haematuria?

what does each subsection split into?

A

urological causes - upper urinary tract and lower urinary tract
non-urological causes - pseudo-haematuria and medical

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5
Q

what is classed as the upper urinary tract?

A

bladder up

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6
Q

what is classed as the lower urinary tract?

A

bladder down

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7
Q

what is pseudohaematuria?

A

red/brown urine not caused by blood, instead a result of medications, hyperbilirubinuria, or foods

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8
Q

what foods can cause pseudohaematuria?

A

beetroot or rhubarb

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9
Q

what meds can cause pseudohaematuria?

A

rifampicin
methyldopa

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10
Q

what is methyldopa?

A

anti-hypertensive

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11
Q

what is rifampicin?

A

ansamycin antibiotic used to treat TB, leprosy, mycobacterium avium complex and legionnaire’s disease

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12
Q

list 4 medical non-urological causes of haematuria?

A
  • glomerulonephritis
  • thin basement membrane disease
  • haemolytic uraemic syndrome
  • multi-system diseases (Good Pasteur’s disease)
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13
Q

what is goodpasteur’s disease?

A

also known as anti–glomerular basement membrane disease, is a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs, glomerulonephritis, and kidney failure

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14
Q

what is glomerulonephritis?

A

inflammation and damage to glomeruli filtration

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15
Q

what is thin basement membrane disease?

A
  • glomerular basement wall in patients with TBM disease appears thinner
  • patients usually retain normal kindey function
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16
Q

what are the two main causes of NS haematuria?

A

IgA nephropathy (glomerulonephritis)
TBMD

17
Q
  • what is haemolytic uraemic syndrome?
  • what triad does it cause?
  • what do pts experience with this syndrome?
A
  • triggered by shiga toxins from e.coli O157 or shigella following gastroenteritis
  • causes triad of: microangiopathic haemolytic anaemia, AKI, thrombocytopoenia
  • pts experience diarrhoea, fever, pain, bruising, confusion, anaemia, hypertension (with renal failure)
18
Q

explain haemolytic uraemic syndrome results in the associated triad of symptoms:
* thrombocytopoenia?
* microangiopathic haemolytic anaemia?
* AKI?

A
  1. clots consume platelets
  2. clots obstruct small vessels and rupture RBCs as RBCs pass through vessels
  3. disrupts blood flow through the kidneys
19
Q

what is the management for haemolytic uraemic syndrome?

A
  • IV fluids
  • blood transfusions
  • haemodialysis
20
Q

if a patient has haematuria, what are the risk factors for the underlying cause being malignant?

A
  • pt is over 60
  • smoking history
  • occupational exposure to paint, dyes, petroleum, metals, hairdressers
  • recurrent UTIs
  • Family Hx bladder cancer
  • schistosomiasis
21
Q

how does smoking affect the chance of a pt’s haematuria resulting from an underlying malignancy?

A

increases it by 3 times

22
Q

what is schistosomiasis?

A

a parasitic worm in the bladder that results in squamous cell carcinoma

23
Q

what are 5 key questions to ask in relation to haematuria?

A
  • amount of blood?
  • colour of urine/blood?
  • relationship of blood to stream (beginning vs end)?
  • presence of clots?
  • urinary/clot retention?
24
Q

why is it important to determine when the haematuria occurs in urination?

A

indicates likely origins of blood:

Blood throughout urination is most likely from the bladder or kidneys or ureters (the tubes connecting the kidneys and the bladder). Blood at the end of your stream may be from the bladder or prostate (in men).

25
Q

when taking Hx of a pt presenting with haematuria, what 7 areas (besides the haematuria) are important to ask about? why?

A
  • flank pain- suggests renal colic
  • **fevers **- infection
  • prostate symptoms - BPH
  • medication history - may be beneficial to withhold antiplatelet/anticoagulation therapy in pts with severe haematuria
  • family Hx - bladder, kidney, prostate cancer
  • social history - smoking and exposure to industrial carcinogens
  • recent travel - schistosomiasis
26
Q

what clinical examinations should be performed if a patient presents with haematuria?

A
  • abdominal examination - tenderness or massess in flanks (renal cancer) or suprapubic region (urinary retention)
  • DRE - enlargement of prostate (cancer) or tenderness (prostatitis)
27
Q

what 4 investigations should be performed if a pt presents with haematuria? why?

A
  • urine dipstick - indicates infection, proteinuria indicates nephrological cause
  • FBC, U+Es, coagulation, CRP - baseline renal function and WBCs may be raised in renal colic
  • group + save / crossmatch - important in pts with VH and who are haemodynamically unstable
  • midstream urine - bacteriuria
28
Q

what two imaging techniques should be performed for pts presenting with haematuria? what does each look at?

A
  • CT urogram with contrast - upper urinary tract
  • flexi cystoscopy - lower urinary tract
29
Q

what are the 3 stages of a CT urogram? what does each look for?

A
  • first image - no contrast
  • second image - contrast through kidneys (looking for renal tumours)
  • third image 20 mins later - contrast is in urine (filling defects in kidney, ureter, bladder - potentially urothelial tumours)
30
Q

what is the emergency management for heavy haematuria or clot retention?

there are 4 steps

A
  • 3 way catheter
  • bladder washout until urine is clear - breaks down and removes clots
  • continuous bladder irrigation
  • admission to urology ward
31
Q

what are the NICE referral guidelines for suspected bladder cancer?

A

if pt is 45 years or older and has:
* unexplained visible hameaturia without urinary tract infection
* visible haematuria that persists or recurs after successful treatment of urinary tract infection
* aged 60 years and over has unexplained non-visible haematuria and either dysuna or a raised WBC count on a blood test

32
Q

what results on urinalysis would indicate infection?

A
  • nitrates - gram-negative bacteria (e.coli) breaks down nitrates (normal waste product in urine) into nitrates
  • raised leukocytes - normal in small amounts, but raised levels indicate infection or inflammation
33
Q

what are the NICE guidelines for diagnosing a UTI?

A

presence of nitrates
leukocytes + RBCs

Med School Year 3 (4 decks)

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