Haematuria

Question 1

What is haematuria?

Answer 1

Blood in the urine

Question 2

What is visible and non-visible haematuria called respectively?

Answer 2

Visible - macroscopic/gross

Non visible - microscopic/dipstick positive

Question 3

When is haematuria diagnosed?

Answer 3

Presence of at least 5 red blood cells per high powered field in 3 consecutive centrifuge specimens obtained at least 1 week apart
OR
Dipstick (usually dipstick tbh)

Question 4

What is spurious contamination?

Answer 4

Discoloured urine caused by contaminants (blood, etc) from a non-urinary tract source

Question 5

List some lower urinary tract symptoms that may present in conjunction with haematuria

Answer 5

Hesitancy
Frequency
Urgency
Dysuria

Question 6

List some upper urinary tract symptoms that may present in conjunction with haematuria

Answer 6

Renal colic (loin to groin pain)

Question 7

List causes of red appearing spurious contamination?

Answer 7

Menstruation 
Food (rhubarb, beetroot)
Myoglobin in urine 
Drugs 
Toxin (lead, mercury)

Question 8

How much blood does it take to give the urine a red appearance?

Answer 8

1ml

Question 9

When is myoglobin found in the urine?

Answer 9

Bywater’s syndrome (crush syndrome)
Rhabdomyolisis (statins)
McArdle sydrome

I.e damage to muscles

Question 10

Which drugs can cause spurious contamination?

Answer 10

Nitrofurantoin (UTI treatment)
Rifampicin
Chloroquine
Senna containing laxatives

Question 11

List the appearance of brown appearing spurious contamination

Answer 11

Porphyrias

Urobilinogen in urine

Question 12

When is urobilinogen found in urine?

Answer 12

Liver dysfunction
Icterus
Haemolysis

Question 13

Blood thinners increase incidence of haematuria. T/F

Answer 13

True in overdose - warfarin, heparin & aspirin

Question 14

Which percentage of patients with frank haematuria have cancer?

Answer 14

20-30%

Question 15

What are the risk factors for serious pathology of the urinary tract?

Answer 15

Smoking
Chemical/dye exposure
Gross haematuria
>40 y/o
History of urologic disorder
History of irritative voiding symptoms 
History of UTI (reassuring)
Analgesia abuse

Question 16

Cystitic can cause frank haematuria. T/F

Answer 16

True

Question 17

What are the infective causes of haematuria?

Answer 17

Uretitis
Cystitis
Ureteritis 
Pyelonephritis 
Prostatitis

Question 18

Can glomerulonephritis cause haematuria?

Answer 18

Yes - autoimmune in origin

Question 19

When does prostatitis cause haematuria?

Answer 19

When it is associated with UTI

Trauma to blood vessels

Question 20

Do UT stones cause haematuria? If so, which type?

Answer 20

The majority of the time - microscopic

Question 21

Can renal tumours cause haematuria? If so, which type?

Answer 21

Yes - commonly frank but either

Question 22

What is the isreal triad?

Answer 22

Pain
Kidney mass
Haematuria

Usually at least one will be present in kidney tumours

Question 23

What types of kidney tumours are there?

Answer 23

Renal cell cancer (renal parencyme)

Transitional cell cancer (renal pelvis, calycs, etc)

Question 24

How do tumours of the lower urinary tract present?

Answer 24

Haematuria
Retention
Urinary irritative symptoms
Loin pain

Question 25

What is sports/joggers haematuria?

Answer 25

Haematuria presenting in patients who do non-contact sport due to vasoconstriction of renal vessels particularly the efferent renal arteriole (--> hypoxic damage to kidney and increased glomerular filtration pressure)

Question 26

What is the natural history of joggers haematuria?

Answer 26

Disappears within a week

Question 27

Can contact sports cause joggers haematuria?

Answer 27

No. But can cause haematuria through trauma

Question 28

What is decompression haematuria?

Answer 28

Occurs when bladder drained too quickly by catheterisation causing rupture of blood vessels

Question 29

Foreign bodies lodged in the urinary tract can cause haematuria. T/F

Answer 29

True

Question 30

Which questions should be asked on taking a history of a patient with haematuria?

Answer 30

``` Gynaecological & surgical history Pneumonuria Faecaluria Vaginal bleeding Abdominal and/or loin pain Weight loss Anaemia ```

Question 31

When do pneumonuria and faecaluria occur?

Answer 31

Pneumonuria - fistula | Faecaluria - fistula (e.g vesico-diverticular)

Question 32

Which aspects of the history are important for generating a differential?

Answer 32

``` Sex (UTI in females ; prostate in males) Age (benign ; cancer) Trauma Country (schistomosis, aristochola) Bleeding disorders Phenacetin abuse (cocaine addicts) History of UTI Occupation ```

Question 33

How does a ruptured kidney present?

Answer 33

Loin pain Haematuria Trauma Malaise

Question 34

How does a ruptured kidney present on CT?

Answer 34

Lots of dark bleeding surrounding where kidney should be

Question 35

How does the colour of urine give a hint as to which pathology?

Answer 35

Dark blood with clots - old pathology | Fresh red blood - something happening right now

Question 36

What do veriform ("worm-like") clots indicated?

Answer 36

Bleeding coming from upper urinary tract | esp if associated with loin pain - renal colic on passing clots

Question 37

How does the timing of the blood help differentiate pathology?

Answer 37

Initial - urethra/prostate Terminal - urethra/prostate/terminal vesicles/bladder neck Total - bladder/kidney/ureter

Question 38

How does pain pattern help differentiate pathology?

Answer 38

Flank - pyelonephritis/renal nephrolithiasis Radiates to groin - renal stones Suprapubic - bladder stone

Question 39

How can haematuria be investigated?

Answer 39

``` Urinalysis Urine culture Cytology Bimanual palpation PR exam Urinary x-ray dye test CT urogram (with/without contrast) ```

Question 40

How is traumatic haematuria investigated?

Answer 40

CT scan (first line) USS MRI