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Hematuria

Hematuria. Tintinalli’s Chap. 97. Painful - infection Painless – neoplastic, hyperplastic, vascular Gross – urine appears “ RED ”; lower tract prob. Microscopic – > 5 RBC’s/hpf; kidney dz False hematuria = urine appears bloody, but dipstick results are neg. for blood and no RBC’s on micro

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Hematuria

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  1. Hematuria Tintinalli’s Chap. 97

  2. Painful - infection • Painless – neoplastic, hyperplastic, vascular • Gross – urine appears “RED”; lower tract prob. • Microscopic – > 5 RBC’s/hpf; kidney dz • False hematuria = urine appears bloody, but dipstick results are neg. for blood and no RBC’s on micro • Free hgb, myoglobin, porphyrins

  3. Table 97-1; 97-2; 97-3 • Initial hematuria = blood at beginning of micturition with subsequent clearing • Urethral dz. • Occuring b/w voiding (staining underclothes) & voiding urine is clear = lesions at distal urethra or meatus • Total hematuria = blood throughout micturition indicates dz of kidneys, ureters or bladder • Terminal hematuria = dz at bladder neck or prostatic urethra

  4. Young pts: nephrolithiasis or UTI; glomerulonephritis (poststreptococcal); immune complex dz, SCC, HSP; Goodpasture syndrome; Wilms tumor • Older pts: infections or nephrolithiasis; renal, bladder or prostate CA; anticoagulant use; AAA can expand and erode into urogential tract; malignant hypertension; embolic renal infarction; renal vein thrombosis • Pregnancy: UTI; nephrolithiasis or preeclampsia • HIV pts: viral renal infection; glomerulonephritis; UTI; chlamydial and gonococcalurethritis; chronic Hep B infxn; neurogenic bladder; thrombocytopenia; uroepithelial Kaposi sarcoma; urethral trauma

  5. Diagnosis: • H & P • Clean catch midstream urine for U/A • Cath urine if woman has vag. d/c, menstrual or vag. Bleeding (cath urine will rarely exceed 3 RBC’s/hpf) • Can screen with dipstick but false negs/pos may result • Abnormal RBC morphologic characteristics, RBC casts & proteinuria suggest glomerular source • If normal RBC’s then infection probable • Imaging (IVP, CT, renal US)

  6. Gross hematuria in blunt or penetrating trauma to abd, flank, or back requires aggressive approach to dx • Tx directed at cause • UTI = axbx • Nephrolithiasis = hydration & analgesics • Systemic dz = directed at cause • Discharge pts that have min. or no sxs, tolerate PO, and have no comorbid conditions • Also should not have significant anemia or renal insufficiency

  7. May need to use 3-way foley to irrigate bladder until clear before d/c pt • Prevent clots in the urethra that would cause bladder outlet obstruction • Admit pts: • Intractable pain • Do not tolerate PO • Significant comorbid illnesses • Bladder outlet obstruction • Hemodynamic instability • Life-threatening cause of hematuria • New dx of glomerulonephritis

  8. Don’t forget in pregnant pts that this could be a sign of preeclampsia, pyelonephritis, or obstructing nephrolithiasis • Consult OB and admit

  9. Hematospermia • Trauma • Other injury (i.e. tumor w/ erosion) • Inflammation (common in men <40 y. o.) • Infection (common in men <40 y. o.) • *Instrumentation of urinary tract • *Radiation therapy • Prostate tumors or BPH (men > 40 y. o.) *most common

  10. Testicle tumors, vascular abnormalities, cyts • Systemic factors: hemophilia, coagulopathies, oral anticoagulants, hypertension, leukemia, lymphoma, scurvy • H & P • U/A • Tx underlying cause (if one identified) • Infxn = axbx • Urologist F/U (esp. if > 40 y.o.)

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