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Hematuria - A Diagnostic Approach

Hematuria - A Diagnostic Approach. Douglas Stahura D.O. GVH 8/24/00. Goals. Epidemiology Evaluation Differential Diagnosis Case Reports. Hematuria - Epidemiology. Definitions Macroscopic - pink, red, or tea colored Microscopic - >4 RBC’s per hpf of spun urine sediment Prevalence

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Hematuria - A Diagnostic Approach

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  1. Hematuria - A Diagnostic Approach Douglas Stahura D.O. GVH 8/24/00

  2. Goals • Epidemiology • Evaluation • Differential Diagnosis • Case Reports

  3. Hematuria - Epidemiology • Definitions • Macroscopic - pink, red, or tea colored • Microscopic - >4 RBC’s per hpf of spun urine sediment • Prevalence • School aged - 4% (always check a 2nd specimen) • >35 y/o - 13% • PPV low, most useful in elderly men

  4. Hematuria - Epidemiology • Specific • Glomerular causes - • Predominate in children and young adults • >40 y/o only 5% of cases • Neoplasm • >40 y/o, Urinary tract 15-20% of cases • Children: Wilm’s tumor, Rhabdomyosarcoma of bladder

  5. Hematuria - Evaluation • History • Physical • Urinalysis

  6. Hematuria - Evaluation

  7. Hematuria - Evaluation • Urinalysis • Proteinuria - indicator of glomerular disease • can be up to 500 mg/24 hr in gross hematuria • RBC cast - must look at urine with your own eyes • Pyuria - look for UTI/STD • Crystals • Dysmorphic RBC’s

  8. Glomerular Dx Renal bx C3,C4, CH50 ASO, ANA, cryoglobulin ANCA, anti-GBM SPEP/UPEP, Ig audio/eye sickle screen Non-glomerular Dx culture Chlamydia, N. gonorrhea renal U/S Flat plate Abd IVP Cystoscopy Hematuria - Evaluation

  9. Hematuria - Cases • Case 1 • 22 y/o WF gross hematuria x2 days • mother of 2: 4y/o, 4mo • works 12 hr shift as waitress, 3 in 4 d • monagamous x 2 years • +/- dysuria, +/- flank pain • PE - no trauma • UA - pro 2+, WBC 5-10/hpf, Bac 1+

  10. Hematuria - Cases • Case 2 • 65 y/o WM gross hematuria x6 weeks • denies pain, freq, hesitancy • 50 pack-yr cigarette • PE - unremarkable • UA - Pro 2+, WBC none, Bac none

  11. Hematuria - Cases • Case 3 • 44 y/o male gross hematuria and episodic flank pain radiating to groin on left side. Unable to find comfortable position. • PE - uncomfortable, distressed, restless • UA - gross hematuria

  12. Hematuria - Cases • Case 4 • 75 y/o male with microscopic hematuria on screening. Hx of hesitancy and weakened urinary stream. • PE - 150/85, enlarged prostate without nodularity/tenderness • UA - 8-10 RBC’s/hpf

  13. Hematuria - Cases • Case 5 • 41 y/o male with 2 episodes of gross hematuria over last 24 hours. • Completed AF marathon yesterday • PE - unremarkable • UA - 15-20 RBC’s/hpf

  14. Hematuria - Cases • Case 6 • 52 y/o female with 4 day hx of upper respiratory sx of cough, fever, scant sputum production. • Over 24h, progresses to Acute respiratory failure • PE - on vent, febrile, normotensive, oliguric, bloody sputum, anemic. • UA - microscopic hematuria, + Legionella antigen, occ dysmorphic RBC’s, BUN/Cr = 54/5.5 CXR - B/L patchy infiltrates

  15. Hematuria - Cases • Case 7 • 39 y/o male construction worker presents to ED with L arm swelling and tenderness. Denies trauma. + warmth/erythema x4d • Teated with Keflex x 7d. • 10 d post ATBX, notices blood in urine • PE - L arm nl, 150/85, NAD • UA - 5-10 RBC/hpf, occ dysmorphic rbc, no casts, bac, WBC reported.

  16. Hematuria - Cases • Case 8 • 20 y/o Japanese exchange student presents with URI sx x1 day. Cough, low grade fever, headache, myalgias. On day two, notices blood in urine. • PE - t=99.2, cough, no sputum, minimal distress. • UA - RBC TNTC, Pro 4+, no casts, no bac.

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