hematuria Flashcards
1
Q
What is first line imaging for hematuria?
A
renal/pelvic u/s
2
Q
When is cytology indicated?
A
symptomatic micro hematuria or macro
3
Q
What is the workup for hematuria?
A
GFR/Cr, ACR, BP… send for micro (must be analyzed within 2-3 hours of collection?!)
4
Q
Single positive micro u/a (3+ RBC) workup + monitoring
A
Work up annually X 3 years if initial workup is negative
5
Q
If > 40 yoa w/ risk factors, refer for
A
cystoscopy
6
Q
risk factors for urothelial CA
A
- Age > 40 years; risk increases with age2
- Male gender (three times higher in men)
- Caucasian ethnicity
- Patients with a personal history of bladder cancer
Environmental
- Smoking, past or present, including exposure to secondhand smoke
- Occupational exposure to chemicals or dyes (e.g. benzenes or aromatic amines)**
- Exposure to certain drugs (phenacetin, cyclophosphamide)
- Overuse of analgesic drugs (phenacetin)
- Exposure to pelvic radiation
Urologic History
- History of gross hematuria
- Chronic inflammation of lower urinary tract. (e.g. chronic indwelling foreign body, chronic urinary tract infection, urethral or suprapubic catheter, ureteric stent, bladder stone and chronically infected stone)
- History of irritative voiding symptoms
- Schistosomiasis haematobium infection (exceedingly rare in North America; endemic to Middle East and Africa)
7
Q
Renal ddx for hematuria
A
benign mass (angiomyolipoma, oncocytoma, abscess) malignant renal mass glomerular bleeding structural disease pyelonephritis hydronephrosis/distension hypercalciuria malignant HTN renal vein thrombus/renal artery embolism arteriovenous malformation papillary necrosis
8
Q
ureteral and bladder ddx for hematuria
A
ureter
- malignancy
- stone
- stricture
- fibroepithelial polyp
- post-surgical conditions
bladder
- malignancy
- radiation
- cystitis
- bladder stones
9
Q
prostate and urethral ddx for hematuria
A
BPH prostate CA prostatic procedures traumatic catheterization urethritis urethral diverticulum
