This document discusses hematuria (blood in the urine). It defines hematuria and notes that not all red urine is necessarily hematuria, as there can be other causes of red or discolored urine unrelated to blood. The document then discusses potential causes of hematuria originating from the kidneys, ureters, bladder, prostate, urethra, and from general systemic factors. It provides details on evaluating a patient with hematuria, including relevant history, examination findings, and potential diagnostic tests.

1. ‫بسم هللا الرحمن الرحيم‬
‫1‬

2. Haematuria in UK English
 Hematuria in US English


Definition: is the passage of red blood
cells in urine.
2

3. 
Not all red urine is Hematuria>> may
caused by
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
Haemoglobinuria
Myoglobinuria
Acute inttermittent porphyria ( error in metabolism of heam)
Beetroot ( name of plant)
Blackberries , food colors
Senna ( name of plant)
Phenolphthalein
Drugs :Rifampicin, Doxorubicin, Chloroquine, Deferoxamine,
Ibuprofen ,Iron sorbitol, Nitrofurantoin, Phenazopyridine
,Phenolphthalein
3

4. 
Kidney
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Glomerular disease
Carcinoma
Stone
Trauma ( including renal biopsy)
Polycystic kidney
TB tuberculosis
Embolism
Renal vein thrombosis
Vascular malformation
4

5. 
Ureter
› Stone
› neoplasm
5

6. 
Bladder
› Carcinoma
› Inflammatory: e.g. cystitis, TB, schistosomiasis
› Stone
› trauma
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7. 
Prostate
› Benign prostatic hypertrophy
› carcinoma
7

8. 
Urethra
› Trauma
› Stone
› Urethritis
› neoplasm
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9. 
General
› Anticoagulant therapy
› Thrombocytopenia
› Strenuous exercise
› Hemophilia
› Sickle cell disease
› Malaria
 (common where malaria is endemic)
9

10. Pain associated with hematuria suggest
infection or inflammation.
 Painless hematuria suggests tumor or
tuberculosis.
 Total haematuria ( throughout the
stream ) suggest bleeding from the
upper urinary tract or bladder.
 Initial hematuria ( at the start of the
stream) suggest bleeding from the
urethra or the prostate

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11. Terminal haematuria (at the end of the
stream) suggest bleeding from the
bladder or the prostate.
 Ask about family history of polycystic
kidney disease
 History of TB
 Any recent foreign travel suggest
schistosomiasis

11

12. Loin pain suggest kidney disease
 History of ureteric colic suggest passage
of a stone or clot down the ureter
 Suprapubic pain, frequency and dysuria
suggest a problem in the bladder
 Difficulty in starting poor stream and
nocturia suggest prostatism ( lower
urinary tract symptoms )

12

13. History of falling astride , pelvic fracture
or trauma suggest urethral injury
 Is the patient on anticoagulant?
 Evidence of sickle cell disease or
exposure to malaria
 History of strenuous exercise
 Has there been any recent renal biopsy?

13

14. 
Others causing red urine not hematuria
› Recent crush injuries or ischemia of the
muscles suggest myoglobiuria with
haemolysis
› Eating or ingestion of substances that make
urin red
› Acute inttermittent porphyria : rare disorder
and accompanied by abdominal pain
 Urine if kept in light become purplish-red ‫احمر‬
‫مائل الى االرجواني‬
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15. 
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Look for anemia, weight loss and signs of
chronic renal failure.
Abdominal examination for palpable mass
egg polycystic kidney disease and
distended bladder
Rectal examination to detect enlargement
in prostate
Feel along the urethra for stones or
neoplasm
Examine the chest for TB and metastasis
from renal cancer.
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16. 
Full blood count and erythrocyte
sedimentation rate ( CBC & ESR)
› Increase in WBCs so infection
› ESR increase so malignancy or TB

Dipstick testing not enough you must do
microscopy

Urine microscopy
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Red blood cells ?
WBCs so infecton
Organisms so infection
Cytology for cancer cells
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17. Urea and electrolytes for renal failure
 Clotting screen for anticoagulant
 Chest X-ray for metastasis
 Kidney Ureter Bladder plain X-ray for
calculus
 PSA for prostate cancer
 Sickling test for sickle cell disease
 Intravenous urography for stones and
tumor and TB.
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17

18. 
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Ultra sound for stone and urinary tract
obstruction
Cystoscopy for infection tumor and stones
Ureteroscopy for tumor and obstruction.
Renal angiography for vascular
malformation and embolism
Renal biopsy for renal tumor and glomerular
disease
Prostatic biopsy for tumor of prostate
18
end

19.  the
most common in the primary
malignant renal tumors
 Occurs in old ages
 males : females 2:1 more common in
male
 derived
from the renal tubular
epithelium ( adenocacinomas)
 1% occur bilateral
19

20. Etiology: increased incidence in those
who smoke tobacco , besides chemical
carcinogens, von Hippel-lindau
syndrome, and polycystic kidney
 Symptoms
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Pain
Haematuria
Weight loss
Flank mass
Hypertension
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21.  Diagnosis by:
› IVP
› Abdominal CT scan with contrast
 Staging
› Stage 1 : < 2.5 cm N0 M0
› Stage 2 : > 2.5 cm limited to kidney N0 M0
› Stage 3 : <2 cm with +ve lymph nodes
localy M0
› Stage 4 : distanat M +ve, >2 cm , +ve N
21

22.  main
routes of metastasis is blood
spread to
› lung
› Liver
› Brain
› Bone
 Bad
prognosis
22

23. 23

24. 
Second most common urologic
malignancy
Transitional cell carcinoma ( most
common) squamous or
adenocarcinoma
 Etiology : increase risk by smoking ,
carcinogens, schistosomiasis, truck
drivers, petroleum workers ,
cyclophosphamide.

24

25. 
Symptoms:
› Painless Haematuria
› Frequancy increase

Diagnosis:
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Urinalysis and culture,
IVP
Cystoscopy
Cytology
biopsy
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26. 
Staging
› Stage 0 : in situ
› Stage 1 : invades sub epithelial tissue
› Stage 2 : invades superficial or deep
musclaris propria
› Stage 3 : invade perivesical tissue
› Stage 4 : N +ve and distant M
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27. 27

28. 28

29. 29

30. Most common genitourinary cancer
 Occur mostly in elderly about 70
 Occur in males more than in females (
for fun only)
 Type : most adenocarcinoma
 Symptoms:

› Asymptomatic
› Found accidentally on PR
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31. Occur usually at peripheral parts of the
gland
 Etiology:

› Not known
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Diagnosis:
› Trans rectal ultra sound
› Trans rectal biopsy
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32. In elderly usually
 Occur at periurethrally
 Symptoms :
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Obstructive symptoms
Urinary retention
Hesitancy
Weak stream
Nocturia
intermittency
UTI
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33. 33

34. 
Diagnosed by
› History
› Digital rectal examination
› Elevated post void residual????
› Urinalysis
› Cystoscopy
› Ultra sound
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35. 
Treatment
› Alpha 1 blockers
› Antiandrogen
› Surgery
› Trans urethral balloon dilatation
35

36. 1.
Glomerular cause
1.
Primary glomerulanephritis
1. IgA nephropathy
2. Post streptococcal glomeruronephritis
2.
Secondary glomerulonephritis
1. Lupus nephritis
2. Vaculitis
3. Henoch Scolein purpura
36

37. Thank
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37
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38. Prostate specific antigen : an enzyme
produced by the glandular epithelium of
the prostate . Increased in quantities are
secreted when the gland is enlarged .
 PSA increase in blood significantly in
case of cancer above 4 ngramml

38

39. Examine the urethral opening and its
place
 Examine the scrotum and testis in male

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