Flashcards in Haematuria Deck (40):
What is haematuria?
Blood in the urine
What is visible and non-visible haematuria called respectively?
Visible - macroscopic/gross
Non visible - microscopic/dipstick positive
When is haematuria diagnosed?
Presence of at least 5 red blood cells per high powered field in 3 consecutive centrifuge specimens obtained at least 1 week apart
Dipstick (usually dipstick tbh)
What is spurious contamination?
Discoloured urine caused by contaminants (blood, etc) from a non-urinary tract source
List some lower urinary tract symptoms that may present in conjunction with haematuria
List some upper urinary tract symptoms that may present in conjunction with haematuria
Renal colic (loin to groin pain)
List causes of red appearing spurious contamination?
Food (rhubarb, beetroot)
Myoglobin in urine
Toxin (lead, mercury)
How much blood does it take to give the urine a red appearance?
When is myoglobin found in the urine?
Bywater's syndrome (crush syndrome)
I.e damage to muscles
Which drugs can cause spurious contamination?
Nitrofurantoin (UTI treatment)
Senna containing laxatives
List the appearance of brown appearing spurious contamination
Urobilinogen in urine
When is urobilinogen found in urine?
Blood thinners increase incidence of haematuria. T/F
True in overdose - warfarin, heparin & aspirin
Which percentage of patients with frank haematuria have cancer?
What are the risk factors for serious pathology of the urinary tract?
History of urologic disorder
History of irritative voiding symptoms
History of UTI (reassuring)
Cystitic can cause frank haematuria. T/F
What are the infective causes of haematuria?
Can glomerulonephritis cause haematuria?
Yes - autoimmune in origin
When does prostatitis cause haematuria?
When it is associated with UTI
Trauma to blood vessels
Do UT stones cause haematuria? If so, which type?
The majority of the time - microscopic
Can renal tumours cause haematuria? If so, which type?
Yes - commonly frank but either
What is the isreal triad?
Usually at least one will be present in kidney tumours
What types of kidney tumours are there?
Renal cell cancer (renal parencyme)
Transitional cell cancer (renal pelvis, calycs, etc)
How do tumours of the lower urinary tract present?
Urinary irritative symptoms
What is sports/joggers haematuria?
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)
What is the natural history of joggers haematuria?
Disappears within a week
Can contact sports cause joggers haematuria?
No. But can cause haematuria through trauma
What is decompression haematuria?
Occurs when bladder drained too quickly by catheterisation causing rupture of blood vessels
Foreign bodies lodged in the urinary tract can cause haematuria. T/F
Which questions should be asked on taking a history of a patient with haematuria?
Gynaecological & surgical history
Abdominal and/or loin pain
When do pneumonuria and faecaluria occur?
Pneumonuria - fistula
Faecaluria - fistula (e.g vesico-diverticular)
Which aspects of the history are important for generating a differential?
Sex (UTI in females ; prostate in males)
Age (benign ; cancer)
Country (schistomosis, aristochola)
Phenacetin abuse (cocaine addicts)
History of UTI
How does a ruptured kidney present?
How does a ruptured kidney present on CT?
Lots of dark bleeding surrounding where kidney should be
How does the colour of urine give a hint as to which pathology?
Dark blood with clots - old pathology
Fresh red blood - something happening right now
What do veriform ("worm-like") clots indicated?
Bleeding coming from upper urinary tract
(esp if associated with loin pain - renal colic on passing clots)
How does the timing of the blood help differentiate pathology?
Initial - urethra/prostate
Terminal - urethra/prostate/terminal vesicles/bladder neck
Total - bladder/kidney/ureter
How does pain pattern help differentiate pathology?
Flank - pyelonephritis/renal nephrolithiasis
Radiates to groin - renal stones
Suprapubic - bladder stone
How can haematuria be investigated?
Urinary x-ray dye test
CT urogram (with/without contrast)