Haematuria Flashcards
What are the classifications of haematuria?
Visible haematuria - blood visible in urine (pink, red or dark brown)
Non-visible haematuria - microscopic or dipstick positive, further subdived into:
- Symptomtic non-visible haematuria - associated symtoms such as suprapubic pain or renal colic
- Asymptomatic non-visible haematuria
What is pseudohaematuria?
Red or brown urine that is not secondary to presence of haemoglobin.
Causes inculde medication (e.g. rifampicin or methydopa), hyperbilirubinuria, myoglobinuria and certain foods (beetroot or rhubarb)
How can causes of haematuria be classified?
Urological: upper tract or lower tract
Non-urological: medical or pseudohaematuria
What are the common urological causes of haematuria?
Infection Malignancy - urothelial or prostate Reanl calculi Trauma or recent surgery Radiation cystitis Parasitic - schistosomiasis
What are the clinical features of haematuria?
Degree of haematuria should be quantified by colour, clots and timing in stream (total haematuria suggests bladder or upper tract source)
Assoicated symptoms - LUTS, trauma and pain
Reg flags
Drug history
smoking - urological malignancies
Industrial carcinogens or recent forigen travel
What initial invesogations would you do for haematuria?
Urinalysis
Baseline bloods
PSA
Dereanged renal function - urine protien levels
What is the urological refferal criteria for haematuria?
Aged ≥45 yrs with either:
- unexplained visible haematuria without UTI
- vissible haematuria th persists or recurs after successful treatment of UTI
Aged 60 yrs with unexplained non-visible haematuria and ethier dysuria or rasied WCC
What are the specialist investigations offered for haematuria?
Flexible cystoscopy - under LA - lower urinary tract - GOLD standard
May do urine cytology - urological maligancy
Upper urinary tract:
USS KUB - non-visble haematuria
CT urogram - visible haematuria
What is management for haematuria?
Treat unerlying cause
