Microhematuria - LaGrange

Question 1

Definition of Asymptomatic Microhematuria

Answer 1

No symptoms, greater than 3 RBCs per high power field on microscopy. Urine dipstick positive for heme no adequate (must have 3 negative micros for one positive dipstick)

Question 2

Risk factors for urologic malignancy (10)

Answer 2

1) Smoking
2) Males (BPH, prostate cancer prevalent)
3) Age >35
4) Occupational exposures (benzene, aromatic amines)
5) Analgesic abuse (phenacetin)
6) H/o gross hematuria
7) Hx pelvic radiation
8) Hx of chronic UTI
9) Hx alkylating chemo
10) Hx of chronic indwelling foreign body

Question 3

How many positive micro UA is sufficient for workup

Answer 3

1

Question 4

Top 3 causes of benign causes of AMH

Answer 4

BPH, UTI, Stones. Others: Obstructions, medical renal disease, benign tumors.

Question 5

Standard imaging for microhematuria

Answer 5

Multiphasic CT without and with IV contrast
A) Non contrast: stones, hydronephrosis, fat lesions
B) Arterial phase: Tumors, inflammatory lesions
C) Venous stage: Scarring
D) Excretory phase: pyelogram, ureters, bladder

Question 6

Cant have a CT with contrast (Pregnant, Contrast allergy, renal insufficiency) what do you do?

Answer 6

1) MRI/MRU without and with gadolinium contrast: Not as good for stones, better for masses. Not good in renal insufficiency
2) Retrograde pyelography: Safe with renal insufficiency. Plus Ultrasound.

-Must need some contrast to see inside kidney

Question 7

What is the best way to rule out bladder cancer?

Answer 7

Cystoscopy- May miss many many bladder tumors depending on how full bladder is.

Question 8

Recommendation for cystoscopy

Answer 8

All patients over 35 or younger than 35 with risk factors