HEMATURIA
Definition: blood in the urine (macroscopic – grossly visible, microscopic – only visible with microscope)
Check urine dip:
+ blood, +RBCs suggests true hematuria
+blood, -RBCs suggests myoglobinuria (such as from rhabdomyolysis)
3 important questions:
1. How old is the patient?
-patients older than 50 years have much increased risk of malignancy (bladder, renal, prostate)
-these patients should be evaluated with urine CYTOLOGY and imaging (CT or IVP)
2. Are there any clues from the history or physical exam?
-concurrent pyuria and dysuria, consider UTI
-recent URI, consider post-infectious glomerulonephritis
-family history of renal disease, consider hereditary nephritis, polycystic kidney disease, sickle cell disease
-unilateral flank pain radiating to groin, consider ureteral obstruction (kidney stone, clot, cancer)
-hesitancy/dribbling, consider BPH
-history of bleeding disorders or bleeding from multiple sites, consider DIC
-cyclic in a woman, consider menses or endometriosis
-living in endemic area, consider Schistosomiasis haematobium
-sterile pyuria with hematuria, consider renal TB
-elevated creatinine consistent with renal failure
2. Is the bleeding from glomerular or extraglomerular source?
-glomerular = RED BLOOD CELL CASTS on microscopy
-also see dysmorphic RBCs and protein >500mg/day
-glomerular causes include IgA nephropathy, Alport syndrome, thin BM disease, post-infectious glomerular nephritis
-extraglomerular = only RBC and clots
