Chapter 5: Hematuria and Proteinuria Flashcards Preview

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Flashcards in Chapter 5: Hematuria and Proteinuria Deck (69)
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1

definition of hematuria

presence of erythrocytes in urine

2

2 types of hematuria

1. macroscopic = grossly visible
2. microscopic = only detectable on urine dipstick

3

if urine is negative for heme, what are some rare causes of discoloration?

- porphyria
- beetroot ingestion
- drugs such as rifampin

4

what are some causes of increased erythrocytes in urine?

- strenuous exertion
- menstruation
- urethral catheterization
- bladder trauma

5

definition of microscopic hematuria

2 or more erythrocytes per HPF on light microscopy in centrifuged sediment

6

causes of hematuria:

hematuria confirmed? if NO

other causes: drugs, pigments, hemaglobinuria, myoglobinuria

7

causes of hematuria:

hematuria confirmed? if YES, what's the next question to ask?

intermittent or sustained?

8

causes of hematuria:

if intermittent, what are some possible causes?

- infection
- "jogger's nephritis"
- menstruation
- catheter associated

9

causes of hematuria:

if sustained, what's the next question to ask?

macroscopic or microscopic?

10

causes of hematuria:

if macroscopic, what's the next question to ask?

is it throughout stream, early in stream, or late in stream?

11

causes of hematuria:

if macroscopic hematuria is is throughout stream, then source is?

kidney origin

12

causes of hematuria:

if macroscopic hematuria is early in stream, then source is?

urethral origin

13

causes of hematuria:

if macroscopic hematuria is late in stream, then source is?

bladder or prostate origin

14

causes of hematuria:

if microscopic, what are the next 2 questions to ask?

does the urine microscopy have CASTS, and is there PROTEINURIA?

15

causes of hematuria:

if microscopic, and there are NO casts, and NO proteinuria

- thin membrane disease
- Alport syndrome

16

causes of hematuria:

if microscopic, and there are casts, and proteinuria

glomerulonephritis

17

what are some risk factors for urologic malignancy? (8)

1. age > 40 years
2. smoking history
3. occupational exposure to benzene or amine dyes
4. h/o gross hematuria
5. h/o chronic cystitis
6. h/o pelvic irradiation
7. h/o cyclophosphamide use
8. h/o analgesic abuse

18

macroscopic hematuria of glomerular origin occurs in what 3 conditions?

- IgA nephropathy
- renal vasculitis
- complication of AC

19

macroscopic hematuria can also occur 2/2 what?

- renal tubular damage
- AKI

20

persistent, isolated hematuria of glomerular origin is important bc it indicates an increased risk of?

ESRD

21

what are the 4 main causes of persistent, isolated hematuria of glomerular origin associated with ESRD?

1. IgA nephropathy
2. Alport syndrome
3. mesangioproliferative glomerulonephritis w/o IgA deposits
4. thin basement membrane disease

22

rare causes of hematuria

- hereditary hemorrhagic telangiectasia
- schistosomiasis
- radiation cystitis

23

- left renal vein compressed between aorta and proximal superior mesenteric artery
- left flank pain
- orthostatic proteinuria
- hematuria

nutcracker syndrome

24

- dysmorphic RBCs
- loin pain (can be severe)
- usually normal kidney function

loin pain hematuria syndrome

25

findings on UA in favor of glomerular bleeding diagnosis

- RBC casts
- proteinuria > 500 mg/day
- dysmorphic RBCs

26

investigation of hematuria:

hematuria suspected, next step?

urine dipstick

27

investigation of hematuria:

pus cells seen on urine dipstick, next step?

urine culture

28

investigation of hematuria:

if hematuria identified on urine dipstick, next step?

urine microscopy

29

investigation of hematuria:

if hematuria identified on urine microscopy: NO casts present, next step?

urine cytology

30

investigation of hematuria:

if hematuria identified on urine microscopy: NO casts present, next step after urine cytology

US and/or CT scan