Treatment - Management of Haematuria

Question 1

What is overt blood in the urine stream, and where is this problem likely to be?

Answer 1

Overt - at the start of urination

This would suggest a problem at the urethra

Question 2

What is diffuse blood in the urine, and where is this problem likely to be?

Answer 2

Diffuse - throughout the urinary stream

Likely to be bladder or above

Question 3

What is end-only blood in the urine, and where is this problem likely to be?

Answer 3

End-only - blood at the end of the stream

Likely to be bladder or prostate

Question 4

What is non-visible haematuria?

Answer 4

Microscopic haematuria

i.e. only detected by urine dipstick

Question 5

Key questions to ask about haematuria?

Answer 5

Macroscopic/Microscopic

Presence of clots

Painful/painless

Duration/consistency

Relation to urinary stream

Any relevant PMH

Question 6

What PMH has a relevant association to haematuria?

Answer 6

Hyperparathyroidism

Gout

Paraplegia

Cystinuria (stones made from cysteine (amino acid))

Stones

Question 7

Which causes of haematuria must be ruled out before investigating further?

Answer 7

UTI

Menstrual blood

Exercise

Poorly controlled anticoagulation

Question 8

What is significant haematuria?

Answer 8

Any single episode of visible haematuria

Any single episode of symptomatic non-visible haematuria in the absence of UTI/other transient cause

Recurring episodes of asymptomatic non-visible haematuria
[] >= 2 out of 3 positive tests

Question 9

What is tested in haematuria urine dipstick test?

Answer 9

Haemoglobin / myoglobin

• by testing peroxidase activity

Question 10

What may be reasons for false positive for blood in urine dipstick tests?

Answer 10

Dehydration

Exercise

Menstrual blood

Question 11

What is the normal excretion rate of RBCs in urine?

Answer 11

1000 RBCs/mL urine

Question 12

Which initial investigations should be done for haematuria?

Answer 12

Plasma creatinine / eGFR

Random sample of urine for protein:creatinine ratio or albumin:creatinine ratio

Question 13

Which patients with haemturia should be referred to urology?

Answer 13

All patient with VH

All patients with s-NVH

Patients with a-NVH >= 40 years

Question 14

What could be the cause for coca cola coloured urine and a concurrent respiratory tract infection?

Answer 14

Glomerulonephritis

Question 15

Why should patients presenting with haematuria be investigated?

Answer 15

A significant amount of VH and NVH patients will have a malignancy (bladder, renal, prostate)

Question 16

List some of the symptoms which may imply nephrological disease in patients with haematuria

Answer 16

Proteinuria

Renal casts (cylindrical casts in kidneys)

Dysmorphic RBCs

Low GFR

High creatinine

High BP

Question 17

List some examples of nephrological disease which may cause haematuria

Answer 17

Glomerular disease

Tubulointerstitial disease

Renovascular disease

Systemic disease

Question 18

List investigations regularly done at a one-stop haematuria clinic

Answer 18

Urine microscopy and culture

Urine cytology

USS of the renal tract

Flexible cystoscopy

Other:

• intravenous urogram
• CT scan