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  1. 1. Hematuria The presence of blood/RBCs in the urine Dr. Prajwal GhimireOrigin:[hemato- [G. haima (haimat-)]+ G. ouron, urine]
  2. 2. Causes
  3. 3. Definition• Macroscopic hematuria: – A substantial haemorrhage into the urinary tract that will give the urine a red or brownish tinge• Microscopic hematuria : – >5 RBCs/hpf on two microscopic urinalyses• Significant microscopic hematuria: – On microscopic examination of the urine, >5 RBCs /hpf in spun urine or >2 RBCs /hpf in unspun urine
  4. 4. Haematuria• Painful or painless• Gross (visible to the naked eye) or microscopic• Initial (only at the start of the stream)• Terminal (only at the end of the stream)• Total• intermittent or persistent• Glomerular or non- glomerular (essential)
  5. 5. • Clots present• Haemospermia (blood also in the semen)• false• Egyptian /Endemic: schistosomiasis hematobium• Renal• Vesical• urethral
  6. 6. • Blood appearing at the beginning of the urinary stream indicates a lower urinary tract cause, whereas uniform staining throughout the stream points to a cause higher up.• Terminal haematuria is typical of severe bladder irritation caused stone or infection.• If the patient experiences pain with haematuria, the characteristics of the pain may help to identify the source of the bleeding.• If there is a malignant cause for the haematuria there is usually no pain.
  7. 7. Investigations for assessment of urinary tractA. Urinalysis1.Dipsticks pH, glucose, protein, blood, bilirubin, Useful screening test for diabetes, ketones, nitrates renal and hepatic disease2.Microscopy RBCs, WBCs, crystals, bacteria May indicate infection or renaland gram stain disease3.Urine culture Number and type of bacteria Diagnosis of UTIB. Blood analysis Hb, platelets, WBCs May detect anemia/polycythemia Urea, creatinine, electrolytes Raised in patients with renal failure Ca++, phosphates, uric acid, albumin Screening for metabolic disorders in renal calculi PSA, AFP, HCG Tumor markers for prostatic ca and testicular ca
  8. 8. C. Imaging1. Structure KUB Detect bony metastases, paget’s disease, soft tissue masses, abnormal calcification IVU Delineates entire urinary tract USG Assessment of renal and scrotal masses and bladder emptying Transrectal USG Useful in assessing prostatic disease CECT Preoperative staging of renal carcinoma2. Function Radioisotope renography Assess function of each kidney DTPA-99mTc-dimercaptosuccinic acid, independently DMSA-diethylenetriamine pentaacetic acid.D. Urodynamics Urine flow rates Useful is assessing degree of obstruction to micturition e.g.:BPH Cystometry (static and ambulant) Differentiates between urge and stress incontinenceE. Endoscopy Cystoscopy Assessment of urinary tract for Ureteroscopy neoplastic or stone disease Ureterorenoscopy
  9. 9. Differential Diagnosis of red urine• Hematuria• Hemoglobinuria/myoglobinuria• Anthrocyanin in beets and blackberries• Chronic lead and mercury poisoning• Phenolphthalein (in bowel evacuants)• Phenothiazines (e.g., Compazine)• Rifampin
  10. 10. Glomerular hematuria
  11. 11. • The urinalysis in nonglomerular medical and surgical hematuria is similar in that both are characterized by – circular erythrocytes and – the absence of erythrocyte casts
  12. 12. An algorithm for the evaluation of essential hematuria
  13. 13. • Is always abnormal whether microscopic or macroscopic ■ May be caused by a lesion anywhere in the urinary tract ■ Is investigated by:• examination of midstream specimen for infection• cytological examination of a urine specimen• intravenous urogram and/or urinary tract ultrasound scan• flexible or rigid cystoscopy• Is commonly caused by urinary infection, especially in young women