Hematuria Flashcards Preview

Internal Medicine > Hematuria > Flashcards

Flashcards in Hematuria Deck (15):
1

Common etiology

Benign prostatic hyperplasia (BPH)
Urinary tract infection
Acute pyelonephritis
Alport's syndrome
Bladder cancer
Prostate cancer
Kidney stone
Instrumentation of the urinary tract
Menstruation

2

Red flags

Bladder cancer
Prostate cancer
Renal trauma
Bladder trauma
Urethral trauma
Sickle cell anaemia
Coagulopathy
Arterial-venous malformation
Renal vein thrombosis
Extrapulmonary tuberculosis
Post-infectious glomerulonephritis
Membranoproliferative glomerulonephritis
Rapidly progressive glomerulonephritis
Systemic lupus erythematosus
Renal cancer
Metastatic cancer
Urethral cancer
Penile cancer
Placenta percreta
Cytotoxic medications

3

Important history

Age
Gender->mensturation, UTI, BPH/Prostate
Timing: initial, terminal or total
LUTS->dysuria, urinary frequency, urgency, and urethral discharge->infection, BPH (UTI, stones)
Pain
Recent vigorous activity
Inflammatory/cytotoxic medications
Exposure to smoke/industrial chemicals.
Periorbital and peripheral edema, weight gain, oliguria
Recent pharyngitis or skin infection
Joint pain, skin rashes, low grade fevers
Risks for STD
FHx->stones, cancer, prostate enlargement, SCA, collagen vascular disease, renal disease
Recent urologic interventions

4

What does initial, terminal or total hematuria indicate

Initial and terminal haematuria represent bleeding from the urethra, prostate, seminal vesicles, or bladder neck. Total haematuria, which is present throughout the void, indicates bleeding of bladder or upper tract (kidney or ureteral) origin.

5

Physical examination

Vitals->hemodynamically stable, T
Pallor->anemia
Periorbital, scrotal and peripheral edema
Cachexia
Suprapubic tenderness
Costovertebral angle tenderness
Palpable bladders
DRE->prostate
Adenopathy
Catheter

6

Investigations

Urinalysis->dip stick, microscopy, cultures, cytology, repeated, followed by microscopic evaluation of urinary sediment if positive
FBE
Coagulation studies

Depending on history:
Complement, ANA, Hep B/Hep C, HIV, Hb electrophoresis, anca->dependant on history
ASOT
CT urography
Cystoscopy

Send for urologist
If +dysmorphic, proteinuria, red cell casts, renal insuffienciency->nephrologist

7

When is complement low

Low serum complement levels are seen in post-infectious glomerulonephritis, SLE nephritis, bacterial endocarditis, and membranoproliferative glomerulonephritis

8

Exaplanation to patient about investigating microscopic hematuria

A complete w/u is necessary to evaluate for the presence of conditions such as infections or tumors, but should be reassured that the incidence of cancer presenting as painless microscopic hematuria is low

9

Glomerular hematura urine

1. Erythrocyte casts
2. Dysmorphic RBCs
3. Proteinuria

10

How does renal hematuria urine compare to glomerular

1. Proteinuria as well
2. Absence of RBC casts and proteinuria

11

What are important causes of interstitial nephritis and what finding on analysis indicates this

1. Analgesics and other drugs
2. Presence of eosinophils

12

Advise when needing to repeat the urinalysis

1. Avoid potential confounders_>menses, medications, exercise for 72 hours, nutritional/herbal, sexual intercourse

13

If UTI found

Treat and repeat urinalysis in 6 weeks->if resolves, no further investigation necessary

14

Is contrast used to visualise stones

No->non contrast CT

15

If patients have negative thorough w/u what are the f/u options

1. Blood pressure
2. Urinalyses
3. Voided urine cytology

6, 12, 24, 36 months