UTIs, hematuria, proteinuria

Question 1

Causes of haematuria

Answer 1

Cancer: bladder (TCC,SCC), kidney (adenocarcinoma), renal pelvis/ureter, prostate
Stones: kidney, ureter, bladder
Infection: bacterial and TB, parasitic (schistosomiasis), infective urethritis
Inflammation: cyclophosphamide cystitis,interstitial cystitis
Trauma: eg catheterisation or peliv fracture
Renal cystic disease:
Other: BPH (if large and very vascular)

NEPHROLOGICAL: IgA nephropathy, postinnfectious GN
COAGULATION ddisorders: congenital, anticoagulation therapy

Question 2

Hx of haematuria important Qs

Answer 2

is the blood definitely in the urine?
What is the colour of th e urine?
How much blood is there?
Is it at the beginning of the stream, throughout or at the end?
Any clots? Size and shape?
Is there pain associated with blood? Any loin pain?

Question 3

haematuria at the beginning of the stream suggests

Answer 3

urethral or prostatic cause

Question 4

haematuria throughout the stream suggests

Answer 4

bleeding from the bladder and above it

Question 5

terminal bleeding in urine suggests

Answer 5

bladder base or prostate

Question 6

size and shape of clots suggest…

Answer 6

round clots - from bladder, long clots from higher up

Question 7

associated urinary sx to Q in haematuria

Answer 7

urgency, dysuria, frequency - ? UTI

obstructive Sx - poor stream, hesitancy, dribbling, incontinence, nocturia (prostate disease)

loin/suprapubic pain - colicky, ? ureteric calculus and clot retention. if constant - inflammation/infection

Passage of stones

frothy urine in proteinuria

Question 8

associated respiratory Sx in haematuria

Answer 8

recent URTI suggests IgA nephropathy

Haemoptysis in pulmonary-renal syndromes

cough, rhhinorhoea, wheeze, epistaxis - ? Wegner’s granulomatosis

Pleuritic chest pain + pleural effusions in SLE

Question 9

rheumatological Q in haematuria

Answer 9

rash, non-blanching purpuric in Henoch-Schonlen
Malar rash in SLE
Arthralgia anad myalgia - SLE or vasculitis
Tight skin, painful and cold fingers - Reynaud’s

Question 10

Systemic Qs in haematuria

Answer 10

fevers and rigors in pyelonephritis, IE, vasculitis

Weight loss, anorexia - ? malignancy or vasculitis

Question 11

other Qs in haemturia

Answer 11

Renal injury

rhabdomyolysis - ? statins, exercise, trauma, drugs

Question 12

PMHx specifically in haematuria

Answer 12

Previous UTIs and calculi
Diabetes, HTN, their complications
Rheumatoid arthritis and SLE
Radiotherapy and chemotherapy
Bleeding disorders
Gout - uric acid calculi

Question 13

SHx in haemturia

Answer 13

Occupation: work in dye, rubber,dry-cleaning industry expses to hydrocarbon solvents (benzenes,ethylenes_ - increased risk of transitional cell carcinoma
Smoking is a risk factor for RCC and TCC
Travel: swimming in water (schistosomiasis)
Sports - long-distance running, marching, boxing

Question 14

causes of false positives for blood in dipstick

Answer 14

myoglobinuria, bacterial peroxidases, povidone, hypochlorite.

Question 15

causes of NOCTURIA

Answer 15

• Urological: benign prostatic obstruction, overactive bladder, incomplete bladder emptying.
• Non-urological: renal failure, idiopathic nocturnal polyuria, diabetes mellitus, central diabetes insipidus, nephrogenic diabetes insipidus, primary polydipsia, hypercalcaemia, drugs, autonomic failure, obstructive sleep apnoea.

Question 16

UTI symptoms

Answer 16

LUTS:• Burning Dysuria • Frequency •Urgency • Haematuria (Macro and Micro) •suprapubic pain
UUTS: •Pyrexia •Loin plain •vomiting

Question 17

UTI aetiology

Answer 17

E. coli 80%, Klebsiella, Proteus

Question 18

UTI classification

Answer 18

Uncomplicated occurs in a healthy patient with no structural/functional abnormalities in the urinary tract

Complicated when there are structural/functional abnormalities

Recurrent: >3 episodes in a year