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Flashcards in hematuria Deck (17):
1

incidental asymptomatic microscopic hematuria - do not routinely screen, but if found needs thorough work-up

*determine risk for STD, chemical, strenuous exercise, drugs, meds, supplements
*urine culture to r/o infection
*repeat UA (need 2 positive tests before further workup, if high risk factors with low RBC # then still work up)
*if persists or high risk factors do work-up:
serum Cr
urine cytology r/o transitional cell carcinoma
image upper UT via IV pyelogram or CT scan, lower UT via cystoscopy, voided cytology to r/o malignancy (low incidence if asymptomatic)

2

urinary tract cancers

renal cell carcinoma
transitional cell carcinoma (bladder + urethra)

3

visible blood in urine (red, brown)

gross hematuria

4

lower urinary tract

bladder + urethra

5

upper urinary tract

kidney + ureters

6

3 or more RBCs/HPF on 2 or more UAs (incidental finding usually)

microscopic hematuria

7

causes of hematuria

glomerular: + lots protein, RBC casts, dysmorphic RBCs
renal: secondary to tubulointerstitial, renovascular (hypertension, diabetes, autoimmune), metabolic d/o, + lots protein only, RBC casts
urologic: tumor, kidney stones, infection, trauma, BPH, NO protein, casts, etc.

8

properly collected UA

freshly voided
early morning
clean-catch (reduce FP rate)
midstream
examine within 2 hours and refrigerate

9

ways of measuring hematuria

number of RBCs/mL of urine excreted (chamber count)
direct examination of centrifuged urinary sediment (sediment count)
indirect exam of urine by dipstick (simplest way low specificity (can't distinguish RBC from myoglobin or hemoglobin) - must be confirmed by microscopic evaluation of urinary sediment)
-look for dysmorphic RBCs, casts, eosinophils

10

risk factors for malignancy

smoking
chemical or dye exposure (benzene, aromatic amines)
hx of gross hematuria
>40 yo
hx of urologic d/o or disease
hx of irritative voiding dx
hx of UTI
analgesic abuse (causes interstitial nephritis)
hx of pelvic radiation

11

urinary sediment can distinguish

glomerular disease from interstitial nephritis:
RBC casts + dysmorphic RBC = renal glomerular disease
eosinophils = interstitial nephritis (analgesics)

12

causes of transient microscopic hematuria (negative 2nd UA)

sexual intercourse
heavy exercise (resolves in 3 days)
recent digital prostate examination
menses contamination

13

if microscopic hematuria and + UA for infection

obtain urine culture (clean catch, midstream)
treat UTI
repeat UA in 6 weeks

14

upper urinary tract imaging

IVP w/ contrast or US (no contrast): may miss small lesions
CT scan: high sensitivity/specificity for masses, stones, infections, obstruction (no contrast for stones then do contrast)
N-acetylcysteine or IV NaHCO3 to reduce risk of contrast nephropathy

15

if workup for microscopic hematuria is negative

f/u bp, UA, voided urine cytology at 6, 12, 24, 36 mo
if negative and asymptomatic no further work-up
if becomes gross hematuria, voiding difficulties, pain, abnormal cytology - consult urology
if get HTN, proteinuria, glomerular casts, abnormal renal function - consult nephrology

16

gross hematuria - always need full work-up

UA + urine culture
image upper UT via CT scan

17

dysuria + UA with microscopic hematuria
boggy, tender prostate

prostatitis
1 mo antibiotics
f/u UA and culture, if still + need further work-up