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Flashcards in Hematuria Deck (22)
1

What is GROSS hematuria?

- VISIBLE blood in the urine
*urological cancer is found 23% of the time.
*no etiology is found only 8% of the time.

2

**** What is MICROSCOPIC hematuria? (TEST QUESTION)

- greater than 3 RBC/hpf in a single specimen.
*43% of the time there is no evident cause.

3

**** How the body help to treat a large bladder clot? (TEST QUESTION)

- urokinase= converts plasminogen to plasmin, leading to clot lysis.

4

What are some drugs that can cause red urine?

- RIFAMPIN
- phenazopyridine
- sulfamethoxazole (Bactrim)
- Nitrofurantoin
- Ibuprofen
- Phenytoin
- Methyldopa
- Chloroquine
- Phenacetin
- Levodopa
- Quinine

5

How sensitive and specific is a urine dip stick?

- 95% sensitive
- 75% specific
*MUST GET MICROSCOPIC URINALYSIS if you get a positive result on dip stick screening test.

6

What is a microscopic urinalysis?

- clean catch or catheterized urine is centrifuged and then examined under hpf.

7

What microscopic urinalysis results would point you toward a nephrologic cause?

- 2+ protein (proteinuria), dysmorphic RBCs, or RBC casts

8

What are the 3 general causes of hematuria?

1. glomerular (nephrology)
2. nonglomerular (upper or lower tract)
3. pseudohematuria

9

What is your DDx for hematuria?

- period (pseudohematuria)
- prostatitis, prostate cancer, BPH
- obstructive uropathy (nephrolithiasis or ureteral tumors).
- nephritis (glomerulonephritis, interstitial nephritis...)
- trauma of GU system
- tumors of the GU system (bladder, renal, ureteral, prostatic).
- hematologic (anticoagulation, bleeding disorders, sickle cell)
- infection/inflammation (cystitis, pyelonephritis, chronic foley, TB)
- stones
- previous irradiation or chemo
- arteriovenous fistula
- beet consumption
- occupational exposure

10

How do you evaluate hematuria?

- thorough H&P

11

How should you carry out a diagnostic eval of hematuria?

1. microscopic urinalysis
2. urine culture
3. urine cytology
4. cystoscopy
5. imaging

12

What is urine cytology?

- microscopic examination of exfoliated urothelial cells obtained by voided urine or bladder washings.
- cells are less cohesive in poorly differentiated tumors, therefore, cytology will be more likely to detect the tumor.

13

Should you always do urine cytology?

- ALWAYS for GROSS hematuria, but optional for microscopic hematuria.

14

Should you always do cystoscopy?

- ALWAYS for GROSS hematuria, but optional in patients less than 35 y/o with microscopic hematuria.

15

What is the gold standard imaging eval?

- CT urogram= CT of the abdomen and pelvis with 3 phases (noncontrast, nephrogenic, and excretory).

16

What are some additional tests to consider?

- CBC
- BMP (check creatinine)
- PSA
- coagulation parameters

17

When should you send a patient to the ER?

- If the patients are passing clots.
- Do NOT feel like they are emptying their bladder.
- associated with dizziness or hypotension

18

How do you treat gross hematuria?

- resuscitate with transfusion if necessary.
- consider holding anticoagulation
- place a LARGE foley to HAND irrigate the bladder.
- if severe, may need to start continuous bladder irrigation (3 way foley catheter)

19

What should you do if gross hematuria persists for days?

- OR for cystoscopy and endoscopic intervention

20

What can cause hematuria in pregnancy?

- spontaneous renal rupture
- placenta percreta

21

What are some predisposing risk factors for bladder cancer?

- recurrent UTIs
- chronic indwelling foley catheters

22

What are most bladder cancers?

- urothelial (transitional cell) carcinoma