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Flashcards in Hematuria Deck (18)

Microscopic hematuria

presence of 3 or more RBCs per HPF on two or more properly collected UA


Etiologies of hematuria (name three classes)

glomerular, renal (nonglomerular), and urologic


glomerular hematuria characteristics

- associated with dysmorphic RBCs, erythrocyte casts, and significant proteinuria


renal hematuria characteristics

- significant proteinuria but no dysmorphic RBCs or erythrocyte casts
- secondary to tubulointerstitial, renovascular, and metabolic disorders


urologic hematuria characteristics

-caused by tumors, calculi, infections, trauma, BPH
- NO proteinuria, dysmorphic RBCs, or erythrocyte casts


When to start routinely screening for bladder cancer

NOT RECOMMENDED IN ASYMPTOMATIC PATIENTS, even though malignancy is found in 5% of all patients with incidental asymptomatic microscopic hematuria


Ways to quantitatively measure hematuria

chamber count, sediment count, dipstick (simplest way, but limited specificity)


What to do if urine dipstick positive for hematuria

evaluate urinary sediment


risk factors for bladder cancer

- smoking
- age older than 40
- history of gross hematuria
- occupational exposure to chemicals or dyes (benzenes or aromatic amines)
- hx of UTI
- analgesic abuse


What to do if UA shows significant proteinuria, red cell casts, renal insufficiency, or predominance of dysmorphic RBCs

evaluate for renal parenchymal disease or refer to nephrologist


How to distinguish glomerular bleeding from lower urinary tract bleeding

glomerular - associated with mostly dysmorphic RBCs
lower urinary tract - associated with mostly normal RBCs


How to distinguish glomerular disease and interstitial nephritis

evaluate urinary sediment!

glomerular - dysmorphic RBCs, erythrocyte casts,
interstitial nephritis - eosinophils, often caused by analgesics or other drugs


If UA with microscopy positive for hematuria and probable cause is determined (menstruation, drugs, strenuous exercise, recent urologic procedure), what to do next?

repeat UA with microscopy 6 weeks after cause is discontinued/treated, if negative again and asymptomatic, no further work up needed


what can cause transient microscopic hematuria

intercourse, strenuous physical exercise (resolves in 72 hours), digitial prostate exam, menses contamination


How to rule out UTI

urine culture


Full workup of microscopic hematuria

- detailed physical and history
- UA with microscopy (repeat if needed)
- assessment of renal function (creatinine, GFR to rule out renal parenchymal disease)
- urine culture to rule out UTI
- imaging of upper and lower urinary tract (i.e. CT urography)

always try to rule out malignancy! (renal cell carcinoma or transitional cell carcinoma)


If thorough work up for hematuria is negative, how often to follow up?

UA with microscopy repeated annually for 2 consecutive years


If persistent asymptomatic microscopic hematuria...

repeat evaluation within 3-5 years of initial eval