Haematuria.pptx
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Haematuria, or blood in the urine, can be caused by medical or surgical issues involving the kidneys, ureters, bladder, prostate or urethra. Initial evaluation of haematuria involves taking a focused history on symptoms, performing a dipstick urinalysis and urine microscopy to determine if further investigation is needed. Significant haematuria risks include single episodes of visible haematuria over age 45, non-visible haematuria over age 60, or persistent asymptomatic haematuria. Initial investigations may include renal function tests, urine culture and cytology, ultrasound or CT urogram to identify the cause or presence of cancer.
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Dr. Sanjay R.P. and Dr. Rajendra Prasad chaired a discussion on the evaluation and management of hematuria. Hematuria is defined as the presence of red blood cells in urine and can be classified based on intensity, origin, relation to urination, etiology, and associated symptoms. Evaluation involves a history and physical exam to determine the cause and guide appropriate testing such as urine analysis, cystoscopy, imaging studies. For microscopic hematuria, initial evaluation includes risk assessment for malignancy and medical renal disease to guide further urologic or nephrologic evaluation if needed.
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Haematuria.pptx
- 2. Introduction • Presence of RBC/Blood in Urine. • Just 1 ml of blood can cause a litre of urine to become red • Common referral for Urologist – 2WW Haematuria clinic • Haematuria – Visible haematuria(VH):20% will have malignacy – Non-visible haematuria(NVH):5% risk of cancer • Symptomatic (s-NVH):LUTS • Asymptomatic (a-NVH):Incidentally detected
- 4. Red Urine • Myoglobinuria • Haemoglobinuria • Beeturia • Medications – Rifampicin – Doxorubicin
- 5. Significant haematuria • Single episode of unexplained VH(>45yrs) • NVH(>60yers) – Single episode of s-NVH in absence of UTI. – Persistent a-NVH (two out of three dipsticks) in the absence of UTI or other. • Anti-coagulant and anti-platelet therapy should not inhibit evaluation of patients with VH or NVH.
- 6. Causes for haematuria • Medical(Nephrology) Vs Surgical(urology) causes • Painful Vs Painless Haematuria • Renal Vs Ureter Vs Bladder Vs Prostate Vs Urethra
- 9. Causes of Haematuria Painful • urinary tract infection • Urolithiasis/calculus • Papillary necrosis – DM,Sickle cell,Pyelonephritis,NSAID • Clot colic:?cancer • Trauma Painless • Cancers – Bladder – Renal pelvis,Ureter – Renal • Benign – BPH – GN – TB – PCKD – Warfarin
- 11. • Cola-coloured urine – ?acute glomerulonephritis Nephrology referral
- 12. Focused History • Exclude pseudohaematuria – drugs, vegetable dyes, pigments(Hb,Mb) • Painful/Painless • Associated symptoms – LUT,Loin pain,fever,bleeding diathesis • Passing clots – large thick clots:non-glomerular bleeding(bladder) – small, stringy clots (upper tract) • PMH,PSH
- 13. Focused history • Relation of gross haematuria to urinary stream – initial stream :Urethra – Total stream: bladder proper or upper urinary tract – terminal stream – bladder neck of prostatic urethra • Cyclical/monthly haematuria – Relation to menstruation:endometriosis • Cancer risk factors – Smoking,occupation:dye,paint,rubber – pelvic radiation,cyclophosphamide • Medications:Clopidogrel,warfarin,Apixaban..
- 14. Dipstick testing for haematuria • Haemoglobin, which contains peroxidase, comes in contact with orthotolidine – Oxidation reaction Colour change(Blue) • False positive(presence of oxidizing agents in the urine) – Povine iodine – hypochlorite solutions – After exercise/dehydration – Hb,Mb – menstrual blood • False negatives (presence of reducing agents) – Vitamin C
- 15. UFR • Always do Urine microscopy after positive dipstick. • Dipstick – ‘trace’ versus ‘1+’ – Trace= insignificant – significant haematuria = 1+ or greater • 1-3 RBC/hpf of spun urine is considered unremarkable.
- 16. Investigations • Dipstick of Urine • UFR • MSU:Urine culture • Renal function:S.Cr,eGFR • Urine cytology • US/KUB • Flexible cystoscopy • CT/Urogram
- 17. Initial Investigations for a patient with s-NVH and persistent a-NVH • Exclude UTI and other transient causes • Measure blood pressure • Measure plasma creatinine/eGFR • Measure proteinuria and protein:creatinine (PCR) or albumin:creatinine ratio (ACR) on a random urine sample
- 18. Re-Referral to
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