Urology - Haematuria Flashcards
list 10 causes of haematuria:
- UTI
- renal cancer
- bladder cancer
- prostate cancer
- BPH
- glomerulonephritis
- thin basement membrane disease
- haemolytic uraemic syndrome
- renal calculi
- schistosomiasis
- trauma - eg catheter insertion
what % of pts with visible haematuria have an underlying malignancy?
14%
% is less in pts under 45
what % of patients with non-visible haematuria have an underlying malignancy?
3%
% is less in pts under 45
what are the two main subsections in the aetiology of haematuria?
what does each subsection split into?
urological causes - upper urinary tract and lower urinary tract
non-urological causes - pseudo-haematuria and medical
what is classed as the upper urinary tract?
bladder up
what is classed as the lower urinary tract?
bladder down
what is pseudohaematuria?
red/brown urine not caused by blood, instead a result of medications, hyperbilirubinuria, or foods
what foods can cause pseudohaematuria?
beetroot or rhubarb
what meds can cause pseudohaematuria?
rifampicin
methyldopa
what is methyldopa?
anti-hypertensive
what is rifampicin?
ansamycin antibiotic used to treat TB, leprosy, mycobacterium avium complex and legionnaire’s disease
list 4 medical non-urological causes of haematuria?
- glomerulonephritis
- thin basement membrane disease
- haemolytic uraemic syndrome
- multi-system diseases (Good Pasteur’s disease)
what is goodpasteur’s disease?
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
what is glomerulonephritis?
inflammation and damage to glomeruli filtration
what is thin basement membrane disease?
- glomerular basement wall in patients with TBM disease appears thinner
- patients usually retain normal kindey function
what are the two main causes of NS haematuria?
IgA nephropathy (glomerulonephritis)
TBMD
- what is haemolytic uraemic syndrome?
- what triad does it cause?
- what do pts experience with this syndrome?
- 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)
explain haemolytic uraemic syndrome results in the associated triad of symptoms:
* thrombocytopoenia?
* microangiopathic haemolytic anaemia?
* AKI?
- clots consume platelets
- clots obstruct small vessels and rupture RBCs as RBCs pass through vessels
- disrupts blood flow through the kidneys
what is the management for haemolytic uraemic syndrome?
- IV fluids
- blood transfusions
- haemodialysis
if a patient has haematuria, what are the risk factors for the underlying cause being malignant?
- pt is over 60
- smoking history
- occupational exposure to paint, dyes, petroleum, metals, hairdressers
- recurrent UTIs
- Family Hx bladder cancer
- schistosomiasis
how does smoking affect the chance of a pt’s haematuria resulting from an underlying malignancy?
increases it by 3 times
what is schistosomiasis?
a parasitic worm in the bladder that results in squamous cell carcinoma
what are 5 key questions to ask in relation to haematuria?
- amount of blood?
- colour of urine/blood?
- relationship of blood to stream (beginning vs end)?
- presence of clots?
- urinary/clot retention?
why is it important to determine when the haematuria occurs in urination?
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).
