Is haematuria a normal finding?
Visible haematuria VH aka macroscopic or gross
Non-visible haematuria NVH aka microscopic or dipstick +ve
Classifications of NVH
Symptomatic NVH with suprapubic pain or renal colic
What is pseudohaematuria
Red or brown urine that is not due to haemoglobin
Can be due to rifampicin, methyldopa, hyperbilirubinuria, myoglobinuria and certain foods like beetroot or rhubarb.
Most common causes
Adenocarcinoma of the prostate
Urological causes of haematuria
Trauma or recent surgery
Parasitic due to schistosomiasis
Make sure you know the degree of haematuria - Bright pink, orange or dark brown may suggest non-urological causes
The timing of the blood in the stream -> Total suggests bladder or upper tract, if it is just terminal haematuria suggest potential severe bladder irritation.
Ask about LUTS, fever, rigors, suprapubic pain, flank pain or weight loss or recent trauma
DH and SH
Recent foreign travel
Abdo exam + DRE and/or examination of the external genitalia
Urinalsysis (nitrites +/- leukocytes indicates infection)
Bloods - FBC, U&Es, clotting
PSA might be done
Check A:C ration or protein:crea ratio
US-KUB if idnicated
What indicates urgent referral to urological service?
Aged >45yrs with either....
Unexplained haematuria without UTI
Visible haematuria that persists or recurs after successful treatment of UTI
Aged 60yrs with unexplained non-visible haematuria and either dysuria or raised WCC on bloods
When should referral to nephrologist be done
With likely nephrological diagnosis
Evidence of declining GFR
Stage 4 or 5 CKD
Proteinuria with haematuria
<40 yo with HTN
Flexible cytoscopy = gold standard for assessing lower UT
Upper UT imaging by...
US KUB imaging
CT urogram is more definitive although with a higher radiation exposure.
Treatment of underlying pathology