Haematuria

Question 1

Haematuria is regarded as a symptom of malignancy until proven otherwise. TRUE/FALSE?

Answer 1

TRUE

Question 2

Aside from the urethra, where else can blood in the urine come from?

Answer 2

Haematospermia (blood in semen)

Vaginal bleeding

Question 3

What usually causes haematospermia?

Answer 3

prostate cancer invading the seminal ducts

Question 4

What are the different types of haematuria?

Answer 4

Visible

Or

Non-visible

• Asymptomatic
• Symptomatic

Question 5

What methods are used to pick up non-visible haematuria?

Answer 5

Dipstick

Microscopy

Question 6

What qualifies as non-visible haematuria on microscopy?

Answer 6

3 or more RBCs per high-power field on microscopy

in 2-3 urine specimens

Question 7

What should you ask about in a history for haematuria?

Answer 7

• Smoking
• Occupational exposures (chemicals, dyes, rubber)
• Any gross haematuria in the past
• Age >40
• Specific drug abuse

Question 8

Visible haematuria is a larger indicator of potential cancer than non-visible haematuria. TRUE/FALSE?

Answer 8

TRUE

Question 9

What type of cancer is most commonly associated with haematuria?

Answer 9

Bladder cancer

Question 10

Why do inflammatory changes in the urinary tract lead to haematuria?

Answer 10

Increase blood flow to the organ

Question 11

Give examples of inflammatory conditions which would cause haematuria?

Answer 11

Urethritis
Prostatitis
Cystitis
Ureteritis
Pyelonephritis
Glomerulonephritis

Question 12

Patients who are passing renal or urinary stones experience haematuria. TRUE/FALSE?

Answer 12

FALSE

not all experience haematuria

Question 13

What percentage of patients with renal cell cancer present with haematuria?

Answer 13

50-60%

usually at advanced stages of cancer

Question 14

What do you call bleeding around the kidney, secondary to trauma?

Answer 14

peri-renal haematoma

Question 15

What sports are known to cause haematuria?

Answer 15

Contact sports (trauma)
Jogging (long distance - many develop haematuria which goes away after 1 week)

Question 16

Why should a bladder not be immediately drained with a catheter if a patient is in urinary retention?

Answer 16

Decompression of bladder can cause haematuria

Question 17

What blood thinning medications can be responsible for haematuria?

Answer 17

Warfarin
Heparin
Aspirin

Question 18

What other cause of haematuria is related to the blood itself?

Answer 18

Bleeding disorders

Question 19

What other substances can change urine colour and make patients suspect there is blood in their urine?

Answer 19

Myoglobin (e.g. in rhabdomyolosis)

Food/drugs (e.g. beetroot etc)

Question 20

What condition can mimic haematuria in very young children?

Answer 20

“red diaper syndrome” caused by Serratia marcescens

• causes red discolouration similar to that seen in haematuria

Question 21

What neoplasm is most likely to cause haematuria in children?

Answer 21

Nephroblastoma (20% have frank haematuria)

Question 22

Other than renal calculi, what can be responsible for loin to groin pain?

Answer 22

Blood clots

Question 23

A simple US works to see the bladder, especially when full. TRUE/FALSE?

Answer 23

TRUE

Question 24

On what type of imagine can the collecting system not be viewed clearly, and how do we combat this?

Answer 24

CT imaging

=> we use contrast (Urogram)

Question 25

What other investigations can be used to view the bladder?

Answer 25

cystoscopy

Question 26

Invasive investigation of the ureters and kidneys must be done under general anaesthetic. TRUE/FALSE?

Answer 26

TRUE