Repro - 1-22 - Hematuria

Front 1

Normal indiv has RBC in urine?

Back 1

yes

Front 2

Hematuria definition

Back 2

3 or more RBCs per high powered field on 2/3 collected specimens.

Front 3

Incidence of signif urologic pathology with microscopic hematuria

Back 3

Normal - 5-30%
Higher risk pts - 20-28%

Front 4

Incidence of urological malig with microscopic hematuria

Back 4

Normal - 2%
Higher risk - 9%

Front 5

Incidence of signif urologic patholgoy with gross hematuria

Back 5

18% - Benign path
18% - malignancy.

(SO DEFINITELY WORK IT UP, BUT BE SURE TO REASSURE PTS WHO ARE FREAKING OUT)

Front 6

Gross examination

Back 6

Should confirm if RBCs are there by looking under scope.

Front 7

Gross exam - things that can mimic

Back 7

Red urine - myoglobinuria, hemoglobinuria, anthrocyanin (beets and blackberries), rifampin, lead/mercury.

Orange - phenazopyridine, salfasalazine

Front 8

Urine dipstick

Back 8

RBCs lyse on contact and create a focal dot which eventually coalesces with others.

Front 9

False positive with urine dipstick

Back 9

Free hemoglobin and myoglobin also catalyze the oxidation of the reagent, so they will look positive.

Front 10

Microscopy - false negatives

Back 10

with very dilute urine, red cell lysis can occur to give false negative microscopy (bc microscope picks up intact RBCs) but a positive dipstick.

the dipstick is correct in this case.

Front 11

Presence of many crenated RBCs or acanthocytes

Back 11

suggests glomerular bleeding and "medical-renal disease."

Front 12

Pain in history suggests...

Back 12

infection, obstruction, trauma.

Front 13

Timing of hematuria

Back 13

beginning of stream - urethral

entire stream - intra or supra vesical

end of stream or post void - prostate or bladder neck source.

Front 14

does anticoagulation cause microscopic hematuria?

Back 14

no

Front 15

If history indicates a benign reason for hematuria (e.g. menstruation, UTI, exercise..)

Back 15

repeat urinalysis after 48 hours.

Front 16

When to refer to nephrology

Back 16

glomerular bleeding, signif proteinura or elevated creatinine

Front 17

When to refer to urology

Back 17

gross hematuria, nonglomerular microscopic hematuria (especially without proteinuria)

Front 18

Cytology -

Back 18

Looking for malignant or atypical cells.

Front 19

Upper tract imaging

Back 19

Evaluates renal parenchyma and renal pelvic and ureteral collecting systems.

Examples are IVU, retrograde pyelography, ultrasonography, CT urogram

Front 20

Intravenous urogram (IVU)

Back 20

gives great collecting system visualization but bad at discerning renal masses.

Time consumin

Front 21

Retrograde pyelography

Back 21

Good collecting system viz, doesn't give ANY renal parenchymal viz.

No IV contrast so good with pts with poor kidneys, children or pregnant women.

Invasive and operator dependent.

Front 22

Ultrasonography

Back 22

Noninvasive, no IV contrast.

But not evaluation of the ureter or renal collecting system.

Front 23

CT urogram

Back 23

most often done.

highest sensitivity for detecting urinary tract stone disease.

great for detecting solid or cystic renal masses.

Requires IV iodinated contrast load.

Delivers highest radiation dose of all the modalities.

Front 24

Cystoscopy

Back 24

Direct endoscopic inspection of the urethra and urinary bladder.

Front 25

Where can hematuria arise from?

Back 25

anywhere from renal glomerulus to urethral meatus.

Front 26

Cystoscopy - when to use rigid vs. flexible?

Back 26

Rigid - can pass other instruments that can help treat the issue. (with minimal invasiveness)

Flexible - only for diagnosis.

Front 27

What does a bladder tumor looks like?

Back 27

cauliflower or coral.

Front 28

Summary

Back 28

Hematuria: >3rbc/hpf on 2 of 3 urinalyses
VERY VERY IMP TO KNOW THIS!!!

Confirm by microscopic urinalysis

Evaluate with cytology, upper tract imaging, and cystoscopy
If you treat a benign cause – don’t have to worry about it as much.

Blood in urine, yes you have to eval it. But usually isnt a big deal