Hematuria for patient education

1. Dr.K.Priyatham
MCh Urology, Fellowship in Uro-oncology(RGCI)
Prashanth Hospital

2.  Haematuria is the presence
of red blood cells in the
urine. It can either be:
 Macroscopic
 (Visible / gross haematuria )
 Microscopic
 (Non-visible / dipstick positive
haematuria)

3.  2% to 30% of the adult population
 Incidence of 4 per 1000 patients per year
 In about 50% of cases, a cause can be identified
 6% of new patients seen by urologists
 Hematuria is a sign of malignancy in 7.1% of all outpatients with hematuria during the
clinical course

5.  A single urine analysis with hematuria is common and can result
from menstruation, viral illness, allergy, exercise or mild trauma.
 >3 RBCs per HPF on three urine analyses or a single urinalysis with
>100 RBCs or gross hematuria is SIGNIFICANT.

6.  Analgesics
 Anticoagulants
 Cancer drugs
 Oral contraceptives
 Penicillins (extended spectrum)
 Quinine

7.  Alport syndrome
 Thin basement membrane disease
 Post-streptococcal glomerulonephritis
 IgA nephropathy
 Pauci immune glomerulonephritis
 Lupus nephritis
 Membranoproliferative glomerulonephritis
 Goodpasture syndrome
 Nephrotic syndrome

17. Tumor Stricture

32.  Acute Cystitis (23%)
 Bladder Cancer (17%)
 Benign Prostatic Hyperplasia (12%)
 Nephrolithiasis (10%)
 Benign essential Hematuria (10%)
 Prostatitis (9%)
 Renal cancer (6%)
 Pyelonephritis (4%)
 Prostate Cancer (3%)
 Urethral stricture (2%)

33.  Abdominal or flank pain
 Dysuria, frequency, urgency
 Trauma
 Strenuous exercise
 Menstruation
 Recent URI/ sore throat
 Skin rashes/ skin infection
 Diarrhea (especially bloody)
 Joint pains/swellings
 Medications/toxins
 h/o sickle cell disease or sickle trait

34.  Urethral: First 10-15 mL
 Bladder: Final 10-30 mL
 Upper urinary tract: Throughout

35.  Vital sign: BP, Temperature, HR
 Skin: Rashes, evidence of trauma, bruising
 Abdomen for masses, tenderness (flank, suprapubics), bruits
 Edema (especially periorbital)
 Joint erythema, swelling, warmth
 Paleness, jaundice
 Careful inspection of external genitalia
 P/R

39.  Serum creatinine
 Urea
 CBC
 Peripheral smear & sickle cell test ( if suspicious)
 Serum PSA

49.  Male gender
 Age >35 years
 Past or current smoking history in which the risk correlates with the extent of exposure
 Occupational exposure to chemicals or dyes (benzenes or aromatic amines), such as printers,
painters, and chemical plant workers
 History of gross hematuria
 History of irritative voiding symptoms
 History of chronic urinary tract infection
 History of pelvic irradiation
 History of exposure to cyclophosphamide
 History of a chronic indwelling foreign body
 History of exposure to aristolochic acid
 History of analgesic abuse, which is also associated with an increased incidence of carcinoma
of the kidney

50.  Stones - To prevent stones returning, you should aim to drink up to 3 liters of fluid
throughout the day, every day.
 Keeping your urine clear helps to stop waste products getting too concentrated
and forming stones.

52.  Drink plenty of fluids, especially water
 Empty your bladder often
 Wash up before sex and urinate after it.
 Take cranberry juice/supplements
 Wipe front to back
 Adequate control of blood sugars
 Regular check-up with diabetologist

53.  Patient might confuse concentrated urine for haematuria
 Hematuria is a sign of malignancy in 7.1% of all outpatients with hematuria during the clinical course
 Haematuria + proteinuria = glomerular disease.
 Colicky pain in pt with hematuria suggests stone.
 Painless haematuria without proteinuria suggests coagulation disorders, cancers, structural anomalies.