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Hematuria

How to solve the problem?

What is hematuria? Types hematuria Causes of hematuria Organ affected

The role of the primary care physician

1.Recognize and confirm the finding of hematuria 2.Identify common etiologies 3.Select patients who have to be referred

Etiology
Varied: Inflammatory or immunologic Chemicals Calculi Malignancy

Etiology

Prevalence
Varies with age. Wilms tumors pre school age. Acute post infectious glomerulonephritis school age population. Malignancy of the genitourinary tract adults.

Laboratory studies
Urinalysis o Dip strip analysis o Urine microscopy - 5 RBCs/RBC casts. RBC casts indicate a glomerulotubular source of hematuria o Other cellular elements (WBCs, WBC casts) suggest UTI. A urine culture should be done.

Laboratory studies
Blood Ureum Nitrogen/Serum Creatinin. Elevated levels suggest significant renal disease. Hematologic and coagulation studies.

The laboratory tests ordered for the evaluation of hematuria must be based on the clinical history and the phisical examination

False positive macroscopic hematuria


Hemoglobinuria, myoglobinuria Medication: Rifampicin, metronidazole,

sulfa

Macroscopic hematuria
o With proteinuria

nephrology case. o Without proteinuria urology case.

Imaging studies
Renal and bladder sonography, to identify: hydronephrosis, hydroureter, tumor, urolithiasis. Other imaging

CT-Scan
MRI IVP

Cystoscopy and ureteroscopy to see inside of the bladder and ureter. tumor, stone, bladder outlet obstruction.

Emergency
Colicky pain: pain killer should be given. Severe bleeding: blood transfusion. Blood clot retention: Cystoscopy and blood clot evacuation.

Causes of hematuria
Kidney:
Infection Congenital anomaly Benign or malignant tumor Injury Stone

Causes of hematuria
Bladder:
Infection/inflammation Stone Benign/malignant bladder tumor Injury

Causes of hematuria
Urethral:
Sexual transmitted disease Injury Foreign body Instrumentation

Causes of hematuria
Prostate:
Infection BPH Prostate Cancer

Bleeding disorders

Hematuria is a sign and not a disease. Therapy should be directed at the process causing hematuria.

Treatment
Depend

on the cause. No serious condition no treatment

Treatment
Medical care Asymptomatic (isolated) hematuria generally does not require treatment. If there is abnormal laboratory or imaging - treatment may be necessary.

Treatment
Surgical care Surgical intervention may be necessary in certain anatomical abnormalities UPJ Stenosis Tumor Urolithiasis Other congenital anomaly

Pediatric cases
Persistent microscopic hematuria should be monitored at 6 12 month intervals. Proteinuria, hypertension decrease in renal function should be reffered to pediatrician.

Prognosis
Asymptomatic isolated hematuria is good. Dependent on the primary medical condition that caused the hematuria.

Pitfalls
Failure

to make the correct diagnosis. All reddish urine is not always blood.

Hematuria

History and PE

Urinalysis

Hb / RBC absent

RBC + / Hb -

Hb + / RBC -

Search other cause of red urine

Check RBC morphology

Glomerular

Non Glomerular

Non Glomerular Hematuria

Positive

Urine Culture

Pyelonephritis Cystitis

Negative

Renal US, VCUG Normal

Abnormal

Hydronephrosis VPJO, Tumor MCKD, VUR PCKD Lithiasis

Urine Ca/Cr

Abnormal

Normal

Hypercalciuria Check 24 hr urine

Bleeding disorders idiopathic

Bilateral policystic kidney

Left renal simple cyst

Bladder tumor

Renal stone

Thank you

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