HEMATURIA

Danger Signal that can’t be ignored

• 1. Duration of symptoms and are they painful?

• 2.Presence of symptoms of an irritated bladder

• 3.What portion of the urinary stream has blood present?

1. microscopic hematuria- >3RBC’s/HPF X3 - 100RBC’s/HPF

2.proteinuria>500mg/24hrs or RBC casts -blood cultures, complement levels, HIV, hepatitis, renal biopsy -causes- IGA nephropathy(Berger’s Disease), hereditary nephritis, thin basement membrane disease

3. evaluation- needs to be referred to nephrology

• Red Urine- beets• -red coloring in food• -phenolphthalein• -porphyria• -hemoglobin, myoglobin

• No proteinuria or RBC casts• Evaluation-pyuria, WBC casts-need urine

culture• -urine cytology• -UA of family members• -24 hr urine for calcium and uric acid

• Imaging- CAT with and without contrast• -ultrasound

• Endoscopy-cystoscopy with biopsies, possible retrogrades

• Follow periodic urinalysis

• -single UA with hematuria is common and can result from menstruation,viral illness, allergy, exercise or mild trauma

• -in pediatrics, neoplasms are rare, idiopathic or congenital problems are common

• Gross Hematuria- almost never glomerular bleeding, urologic in nature

• - patients chronically anticoagulated should be evaluated, evaluation is similar to microscopic hematuria, imaging and cystoscopy

Urinary Stones

• Hematuria with colic suggests a stone• Calcium stones- most common,80%, familial• Uric acid stones-radiolucent, more common in

men• Cystine stones-uncommon, diagnosed in

pediatric ages• Struvite stones-common, related to infections,

oftenProteus

• Elevated 24 hr urine for calcium or uric acid

• Evaluation-CAT without contrast, IVP not indicated

• Treatment-ESWL, ureteroscopy, percutaneous surgery, medical treatment may be low sodium, low protein diet, do not restrict calcium, use of thiazides

URINARY TRACT INFECTIONS

Ecoli-80% of infections, others Proteus, Klebsiella, Pseudomonas, catheter patients should not be treated if asymptomaticUA, Urine Culture needed

After each course of treatment, a UA is needed to determine if the treatment was effective or the problem due to something elseMacrodantin, Septra, try to avoid fluroquinolones

NEOPLASMS

Bladder Cancer- common related to cigarette smoking, usually transitional cell, presentation is usually painless hematuria

Treatment- resection of tumor, use of mitomycin, use of BCG, more aggressive tumors treated with chemo, radiation, or cystectomy

Renal Cell carcinoma

The incidence of this tumor is rising, familial factors, hematuria, flank pain, abdominal mass

Treatment- nephrectomy, partial nephrectomy is now used more often,survival is actually better -tumors often are radiation resistant - some new chemotherapy helps

BPH AND PROSTATE CANCER

Bleeding may occur spontaneously from either, without prior manipulation

Treatment- often resection is needed to stop the bleeding

TRAUMA

Renal Trauma- usually treated without surgery

Bladder Trauma- open surgery is needed if rupture is in the peritoneal cavity

Urethral Injury- Local x-ray evaluation is needed to determine the site of injury

TB AND SCHISTOSOMIASIS

• Not common in this area, but in some parts of the world a major cause

Approach should be compulsive in diagnosis

History and exam are very important, presence of pain, blood pressure evaluation, hx of physical activity, food intake

Make sure the blood is gone after the treatment that is given