Haematuria and Proteinuria

Question 0

Pyonephritis

Answer 0

Infected obstructed kidney. Forms an abscess within the kidney. Because it is restricted it can burst into the retroperitoneal space.

Presents with flank pain and fever. Hydronephrosis

Requires urgent drainage, resuss and antibiotics

Question 1

Causes of haematuria

Answer 1

Stones
Cancer
Infections
Trauma

Can be from the kidney, bladder, ureter or prostate

Question 2

Symptoms of UTI

Answer 2

Frequency, urgency, dysuria, abdominal pain.
Normally resolve within 3 days on antibiotics.

Simple UTIs: in women, not reccurrent
Long term infections: low dose antibiotics

Question 3

Diseases you can screen for with urine dipstick

Answer 3

Haematuria, diabetes, jaundice, infection

If dipstick is negative for all, highly likely to be negative. If positive send for MSU.

MSU analyses epithelial cells, WBCs, RBCs and bacteria. Positive MSU sent for culture

Question 4

Non-infectious cystitis

Answer 4

Cystitis symptoms in the absence of a proven infection.

Abdominal pain on filling, dysuria and frequency.

Management difficult. Give cimetidine, anticholinergics, cystistat.

Question 5

Schistosomiasis

Answer 5

Caused by schistosoma worms.

Acute: fever, malaise, myalgia, cough, haematuria

Chronic: caused by deposition of eggs into the bladder causing chronic irritation. Causes squamous bladder cancer.

Question 7

Prostatitis

Answer 7

Presents as perineal and pelvic pain

PR exam: pain when prostate is pressed, normally uncomfortable tingling sensation

Infective: 4 weeks ciprofloxacin
Non-infective: analgesics, anticholinergics, alpha blockers

Question 8

Pathological causes of proteinuria

Answer 8

Glomerular diseases: Increased glomerular permability to protein

Tubulointerstitial diseases: Decreased tubular reabsorption of protein

Overflow causes: increased levels of low molecular weight proteins.

Question 9

How do you assess proteinuria?

Answer 9

Use albumin:creatinine ratio or PCR for microalbuminaemia.

> 70mg/mmol significant >30 significant in diabetics

Question 10

Causes of increased albumin excretion

Answer 10

Strenuous exercise
Protein intake
UTI
Pregnancy
Glomerular damage

Question 11

Normal albumin exretion

Answer 11

24hr urine of >300mg indicated overt nephropathy. 30mg/day normal.

Albumin creatinine ratio:
2.5 micro
>25 proteinuria