Hematuria

Definition- abnormal presence of RBCs in the urine. Can be divided into gross and microscopic hematuria. Microscopic hematuria: 3RBC/HPF in 2 of 3 freshly voided, clean catch, midstream urine samples. Quick Approach blood in urine can originate along any point in the urinary tract (work backwards anatomically from ureters) ie: urethritis-->vaginal blood/prostatitis...-->cystitis... bladder ca/RCC/stone--> pylonephritis..renal infarcts/thrombosis/..-->glomerulonephritis Pathophysiology The pathophysiology of hematuria depends on the anatomic site in the urinary tract from which blood loss occurs Can be divided into glomerular and extraglomerular (nephrologic and urologic) diseases Glomerular- blood originating from nephron. Disruption of the filtration barrier in the glomerulus may result from inherited or acquired abnormalities in the structure and integrity of the glomerular capillary wall. These RBCs can be trapped in Tamm-Horsfall mucoprotein and will be manifest in the urine by RBC casts.1 Finding casts in the urine represents significant disease at the glomerular level. Isolated hematuria- without proteinuria or casts. Anything that disrupts the uroepithelium, such as irritation, inflammation, or invasion, can result in normalappearing RBCs in the urine. ie: malignancy, renal stones, trauma, infection, and medications. Obtaining the Diagnosis History for gross hematuria, timing during stream can help localize initial- urethral; terminal- prostate, bladder, triganol; total- renal associated symptoms helps narrow differential constitutional symptoms; pain (location, radiation); urinary complaints other history to ask about include: family history, recent trauma, strenuous exercise, ingested substances (food, drugs) Physical Exam systemic disease- fever, rash, lymphadenopathy, joint tenderness medical kidney disease- HTN, vol overload urological disease- abdominal pain/masses, flank pain, enlarged prostate Laboratory/Imaging INSERT HARRISONS ALGORITHM

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