Haematuria Flashcards Preview

Y3M - Urology > Haematuria > Flashcards

Flashcards in Haematuria Deck (14)
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1

Is haematuria a normal finding?

Never 

2

Classifications

Visible haematuria VH aka macroscopic or gross

Non-visible haematuria NVH aka microscopic or dipstick +ve

3

Classifications of NVH

Symptomatic NVH with suprapubic pain or renal colic

Asymptomatic NVH

4

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.

5

Most common causes

UTI

Urothelial carcinoma

Stone disease

Adenocarcinoma of the prostate

BPH

6

Urological causes of haematuria

Infection

Malignancy

Renal calculi

Trauma or recent surgery

Radiation cystitis

Parasitic due to schistosomiasis

7

Clinical features

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

 

 

8

DH and SH

Drug history

Smoking status

Industrial carcinogens

Recent foreign travel

9

Examination findings

Abdo exam + DRE and/or examination of the external genitalia

10

Initial investigations

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

11

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

or....

 

Aged 60yrs with unexplained non-visible haematuria and either dysuria or raised WCC on bloods

12

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

13

Specialist investiations

Flexible cytoscopy = gold standard for assessing lower UT

Urine cytology 

Upper UT imaging by...

US KUB imaging

CT urogram is more definitive although with a higher radiation exposure.

14

Management

Treatment of underlying pathology