Urology - haematuria

Question 1

ΔΔ haematuria?

Answer 1

CA and GN until proven otherwise!

• UTI (+ ↑freq + dysuria)
• CA (painless)
• stone (+pain)
• others (GN, menses, PR bleed, BPH, PCKD, alpert’s syndrome + hearing loss, schistosomiasis, DHx - anticoag)

Question 2

Sx blood early in flow suggests?

Answer 2

prostate problem

Question 3

Sx blood throughout flow?

Answer 3

problem with:
bladder
ureter
kidney

Question 4

what things can mimic haematuria?

Answer 4

beetroot in diet
rifampicin, sulfasalazine
haem/myoglobinuria (brown urine)

Question 5

Sx brown urine, blood + on dipstick, but no rbcs on microscopy?

Answer 5

haemoglobinuria
myoglobinuria (associated with rhabdomyolysis or muscle destruction)

neither have rbcs in urine!! (microscopy)

Question 6

Sx of proteinuria, haematuria, rbcs + casts, increased BP, trickle of urine (oliguria) and going for investigations for CA?

Answer 6

nephritic syndrome

PHRITIC Sx

Question 7

causes of nephr-i-tic syndrome?

Answer 7

• 1’ GN (IgA, postinfectious, rapidly progressive)
• HSP
• HUS

Question 8

Ix haematuria?

Answer 8

• urinalysis (dipstick, microscopy - rbcs +/- casts if GN, C+S if UTI, cytology in CA)
• bloods (anaemia, renal function)

specialist tests + imaging if : visible haematuria, or non-visible and >40 yrs

• older: CT urogram (RCC) + cystoscopy (bladder CA)
• younger: screen GN (biopsy)

Question 9

x-linked haematuria, proteinuria, high-tone sensorineural hearing loss, progressive renal insufficiency, RF 30-40 (men), with female carriers exhibiting some of the phenotype?

Answer 9

Alport syndrome

Question 10

when should non-visible haematuria be referred to urology?

Answer 10

eGFR<60
ACR>30, PCR>50 (↑protein)
HT>140
FHx renal

Question 11

when should ASx non-visible haematuria be investigated?

Answer 11

in those >50 years - 2 weeks rule
smokers and FHx of bladder CA - refer

but otherwise, if no Sx, and especially if young & athletic - probs fine/exercise induced!