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18 Cards in this Set
- Front
- Back
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1. The patient presents with asymptomatic microscopic haematuria, what is the initial approach?
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1. Repeat the UA
2. Assess for risk factors 3. Assess the upper and lower urinary tract b. R/o infection by performing a urine culture c. Evaluate for malignancy by imaging of the upper urinary tract, cystoscopy, and voided cytology. |
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2. Primary concerns with the above scenario?
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a. Rule out malignancy, including renal cell carcinoma and transitional cell carcinoma.
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3. How can the upper GU tract be imaged?
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a. By either:
1. IV pyelogram (IVP) or 2. CT |
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4. How is the lower urinary tract most commonly evaluated?
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a. Cystoscopy, an endoscopic procedure.
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5. Note: the incidence of cancer presenting at asymptomatic microscopic haematuria is low.
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5. Note: the incidence of cancer presenting at asymptomatic microscopic haematuria is low.
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6. Microscopic haematuria definition?
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a. The presence of 3 or more red blood cells per HPF on 2 or more properly collected urinalyses.
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7. What should be done for findings of haematuria by the dipstick method?
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a. Should be confirmed by microscopic evaluation of urinary sediment.
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8. Note: if the haematuria resolves treatment UTI, no further workup is needed.
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8. Note: if the haematuria resolves treatment UTI, no further workup is needed.
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9. Utility of cytologic evaluation of the urine?
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a. Assess for transitional cell carcinoma
b. It may not pick up low-grade carcinoma, but it is fairly reliable for high grade carcinoma, especially if repeated. |
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10. IVP?
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a. IVP x-ray imaging of the upper urinary tract after the administration of intravenous contrast dye.
b. It is widely available and relatively low-cost procedure, but in this small renal masses and may not distinguish solid from cystic lesions |
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11. Utility of CT scanning?
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a. Has high sensitivity and specificity for detecting masses, renal stones, renal or perirenal infections, and obstruction.
b. Should be initially performed as a noncontrast study to detect calculi c. And then as a contrast study |
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12. Premedication with what 2 drugs can help with IV contrast nephropathy from both CT scanning and IVP?
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a. N-acetylcysteine or IV sodium bicarbonate
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13. What May be a better imaging study for patients with renal insufficiency who are at high risk of contrast nephropathy?
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a. Retrograde pyelography combined with renal ultrasound.
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14. Retrograde pyelography?
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a. Is an invasive procedure in which a catheters placed in the bladder and dye is injected up the ureters to the kidneys.
b. There is little risk of contrast nephropathy because no contrast dye is given IV. |
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15. How should the lower urinary tract be examined for transitional cell carcinoma?
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a. Cystoscopy by a urologist
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16. In patients with haematuria have a thorough but negative workup what is recommended by the American urologic Association?
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a. Follow-up blood pressure measurements, urinalyses, and voided urine cytologic studies at 6, 12, 24, and 36 months
b. Is the patient remains asymptomatic for 36 months, the patient continues to be symptomatic, no further follow-up is recommended. c. However, the patient developed gross haematuria, avoiding difficulties, pain, or any abnormal psychology, mediate urologic re-evaluation and consultation is warranted. |
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17. Note: haematuria in adults should always be evaluated. If no sources found my thorough initial workup, patients should be followed for at least 3 years to monitor for an underlying condition.
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17. Note: haematuria in adults should always be evaluated. If no sources found my thorough initial workup, patients should be followed for at least 3 years to monitor for an underlying condition.
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18. Exercise-induced haematuria?
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a. Usually resolves on easily in 72 hours in the absence of other coexisting conditions.
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