Lecture 3: Painless and Occult Hematuria

Question 1

What 2 factors related to atheletes may cause hematuria?

Answer 1

• Heavy exercise –> exercise induced hematuria
• Med hx: NSAIDs are common among athletes and can also cause hematuria

Question 2

What tests need to be performed to rule out infection in person w/ hematuria?

Answer 2

Microscopy + Culture/sensitivity

Question 3

Which part of a female pts history is essential when discovering some blood in the urine?

Answer 3

Menstrual history

Question 4

How many RBC’s/hpf in a urine specimen is considered negative for hematuria?

Answer 4

<3 RBC/HPG

Question 5

What are some of the major causes of false positives for hematuria on a urine dipstick?

Answer 5

• Myoglobinuria, hemoglobinuria
• High alkaline urine (pH >9)
• Ascorbic acid (vitamin C)

Question 6

Suspected hematuria on a urine dipstick needs to be confirmed how?

Answer 6

Microscopy

Question 7

A healthy African American pt presenting for wellness exam with a urinalysis revealing 2+ blood should raise suspicion of what?

Answer 7

Sickle Cell Trait (SCT, HbAS)

Question 8

Those with Sickle Cell Trait are at increased risk for what renal dysfunctions and serious long-term complications?

Answer 8

• Impaired concentrating ability
• Can develop renal papillary necrosis
• Hyperfiltration –> albuminuria, interstitial fibrosis, decreased # of nephrons (FSGS)
• Renal medullary carcinoma

Question 9

Major risk factors for transitional cell/bladder cancer?

Answer 9

• Male
• >35 yo
• Current or former smoker
• Analgesic abuse
• Exposure to chemicals, dyes, carcinogens, or chemotherapies

Question 10

If a diangosis of BPH is made in someone with hematuria, does this require further workup?

Answer 10

Yes, diagnosis of BPH should NOT prevent further evaulation of an underlying cause of the hematuria

Question 11

Evaluation of malignancy associated with hematuria should evaluate what serum markers for renal function?

Answer 11

• Renal function: BUN, Cr

Question 12

Which test is recommended in all pts with asymptomatic microscopic hematuria who present with risk factors for malignancy, regardless of age and all pts >35 w/ asymptomatic microhematuria?

Answer 12

Cystoscopy

Question 13

What are the benefits of using ultrasound when evaluating causes of hematuria, and is very good for viewing what causes?

Cons?

Answer 13

• No radiation
• Low cost
• Very good for tumors >3cm, cysts and hydronephrosis
• May miss other causes: small stones, small bladder mass (<3cm) and urothelial transitional cell carcinoma

Question 14

Which type of imaging is highly sensitive for renal calculi?

Answer 14

Computed Tomography Urography

Question 15

With a primary or chronic renal injury there is a reduced number of nephrons which leads to activation of RAAS, which can cause more glomerular damage how?

Answer 15

• Vasoconstriction of afferent arterioles (as well as systemic) and efferent arterioles
• Increases glomerular pressures (hyperfiltration)
• Causes direct glomerular damage

Question 16

Why is a renal ultrasound useful in assessing someone for acute or chronic disease?

Answer 16

• Helps assess size of kidneys
• Generally reduced in chronic disease

Question 17

RBC casts or dysmorphic RBC’s found in urine is indicative of what disease?

Answer 17

Glomerulonephritis

Question 18

Which inflammatory cells will be present in inflammatory glomerulonephritis and should be differentiated from infection (UTI)?

Answer 18

Pyuria (leukocytes)

Question 19

Benign proteinuria is also called what?

Answer 19

Functional or transient

Question 20

Common causes of benign proteinuria?

Answer 20

• Fever
• Exercise
• Obestity
• Sleep apnea
• Emotional stress
• CHF

Question 21

Diabetic nephropathy of which type of DM is associated with glomerular, tubular, interstital and vascular lesion which tend to progress more or less in parallel an independent of albuminuria?

Answer 21

Type 1 DM

Question 22

Hypertensive nephrosclerosis is 5x more common in which race?

Answer 22

Blacks