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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
sulfa
Macroscopic hematuria
o With proteinuria
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
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 -
Glomerular
Non Glomerular
Positive
Urine Culture
Pyelonephritis Cystitis
Negative
Abnormal
Urine Ca/Cr
Abnormal
Normal
Bladder tumor
Renal stone
Thank you
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