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Hematuria Resident Lecture

Hematuria Resident Lecture. Hematuria. Diagnosis: presence of ≥ 3 RBCs on at least 2 separate urine samples Gross: as little as 1cc can visibly change urine Microscopic: detected by UA if there is at least 1-2 RBC/hpf

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Hematuria Resident Lecture

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  1. HematuriaResident Lecture

  2. Hematuria • Diagnosis: presence of ≥ 3 RBCs on at least 2 separate urine samples • Gross: as little as 1cc can visibly change urine • Microscopic: detected by UA if there is at least 1-2 RBC/hpf • Because there are false positives urine microscopy is necessary to confirm presence of RBCs

  3. Evaluation of hematuria • History taking is VERY important • Risk factors • Smoking history • Occupational exposure to chemicals or dyes (benzenes or aromatic amines) • History of gross hematuria • Age >40 years • History of urologic disorder or disease • History of irritative voiding symptoms • History of urinary tract infection • Analgesic abuse • History of pelvic irradiation • Systemic symptoms, exposures, exercise, infections, BPH, stones, dysuria, etc.

  4. Evaluation of hematuria • Urine microscopy confirms RBCs present? • Gross v. microscopic hematuria? • Proteinuria present, how much? • Glomerular v. nonglomerular? • Glomerular: RBC casts, dysmorphic RBCs, proteinuria (typically > 1 gm), coca-cola color • Nonglomerular: nondysmorphic RBCs, clot formation (very rare in glomerular bleeding) • Indeterminate: presence of less than < 30 % dysmorphic RBCs, Proteinuria < 1gm, no RBC casts • Renal U/S results?

  5. Etiology of Glomerularhematuria • Glomerulonephritis • Systemic disease (autoimmune) • Vasculitis – (WG, MPA, CS, HSP) • Lupus • TMA • Scleroderma • Hereditary/Other • Alport’s • TBM • Infection-associated GN • Nutcracker syndrome • Loin-pain hematuria

  6. Evaluation of nonglomerularhematuria - LUT

  7. Imaging studies for nonglomerularhematuria

  8. Outcome • 1% of older patients with an initially negative evaluation will, at three to four years, have a detectable urinary tract malignancy • In high risk patients, f/u cytology at 6, 12, 24, 36 months, consider repeat cystoscopy annually for persistent hematuria

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