hematuria Flashcards
what can cause transient hematuria
sex, exercise, menses, urologic procedures (digital rectal examination).
what is the first step in determining the etiology of hematuria
determine if its gross or microscopic.
what is the simplest way to determine microscopic hematuria
urine dipstick analysis.
what are some other ways to examine a urine sediment for hematuria
urine sediment analysis, direct examination of centrifuged urine sediment. indirect via dipstick analysis
do urine dipsticks have false positives or negatives?
false positives can occur because dipsticks cannot tel the difference between hemaglobin and RBCs. false negatives are very rare and not usually a consideration.
If urine is positive on dipstick analysis for hematuria, what is the next step
the next step is microscopic analysis. every positive should be followed up with microscopy.
what should prompt further workup for renal parenchymal disease
significant proteinuria, red cell casts, renal insufficiency, predominance of dysmorphic RBCs.
what is indicative of glomerular disease vs lower urinary tract bleeding
glomerular is typically associated with dysmorphic RBCs, while lower tract bleeding is associated with normal RBCs.
eosinophils in the urine is indicative of what?
interstitial nephritis.
If mircoscopic hematuria is positive then what?
look for benign causes such as menses, exercise, sexual intercourse, urologic procedures
If microscopic hematuria and identifiable benign cause, then what?
reschedule UA for 6 weeks out. reexamine the urine. if negative, no further workup necessary
if hematuria is suspected what is the plan
should begin with urine sediment analysis, microscopy, UTI should be ruled out with culture. serum creatinine to assess renal function.
what if hematuria with elevated creatinine
then further workup for renal parenchymal disease is required. ( look for hypertension, diabetes, autoimmune eitoplogies.)
what is the best imaging modality for the upper urinary tract?
CT urology is the best.
when do we use urine cytology and urine markers?
only in patients with suspected bladder cancer or the risk factors (smoking, occupational hazards, dyes, etc.)
