This document discusses hematuria (blood in the urine) and obstructive uropathy (blockage of urine flow in the urinary tract). It covers evaluating hematuria through urinalysis, imaging tests, and cystoscopy. Common causes of hematuria include infections, stones, tumors, and glomerulonephritis. Obstructive uropathy can be congenital or acquired and cause changes to the urethra, bladder, ureters, and kidneys over time. Relieving the obstruction through surgery, stents, or nephrostomy is the main treatment approach.

1. Hematuria & obstructive Uropathy

2. Hematuria

3. Physical Examination of Urinean evaluation of color, turbidity, specific gravity and osmolality, and pH.

5. Urinary dipstickMost common screening test for hematuria

6. The reagent strip that detects blood utilizes hydrogen peroxide, which catalyzes a chemical reaction between hemoglobin (or myoglobin) and the chromogentetramethylbenzidine

7. Different shades of blue-green are produced according to the concentration of hemoglobin in the urine

8. Centrifuged urine

9. Centrifuged urineIn hemoglobinuria, the supernatant will be pink. This is because free hemoglobin in the serum binds to haptoglobin, which is water insoluble and has a high molecular weight. This complex remains in the serum, causing a pink color. Free hemoglobin will appear in the urine only when all of the haptoglobin-binding sites have been saturated.

10. Centrifuged urineIn myoglobinuria, the myoglobin released from muscle is of low molecular weight and water soluble. It does not bind to haptoglobin and is therefore excreted immediately into the urine. Therefore, in myoglobinuria the serum remains clear.

11. Quantity of HematuriaMicroscopic Hematuria : seen only under microscopeGross Hematuria : visible, urine is pink, cola, red5 times the number of life-threatening conditions when compared with patients with microscopic hematuria.

12. How to evaluate hematuria?By asking questionIs the hematuria gross or microscopic?

13. At what time during urination does the hematuria occur (beginning or end of stream or during entire stream)?

14. Is the hematuria associated with pain?

15. Is the patient passing clots?

16. If the patient is passing clots, do the clots have a specific shape? Timing of HematuriaFrequently indicating the site of origin asInitial hematuria from urethra, least common, usually secondary to inflammationTerminal hematuria secondary to inflammation at bladder neck or prostatic urethraTotal hematuria from bladder or upper tract, most common

17. Total HematuriaTerminal HematuriaInitial Hematuria

18. PainPainful hematuria

19. Painful micturition

20. inflammation of the bladder or prostate.

21. Colicky groin pain

22. ureteral calculus.

23. Burning pain in the penis or urethral opening in women

24. urinary infection.

25. Pain in the perineum associated with dysuria, fever, and rigors

26. seen in prostatitis.

27. Constant dull flank pain

28. sign of advanced RCCClassification : PainPainless (Gross) HematuriaWith Age > 50 years ( Mostly Men ) is HALLMARK for bladder cancer.

29. ClotsThe presence of clots usually indicates a more significant degree of hematuria, and, accordingly, the probability of identifying significant urologic pathology increases.

30. Shape of ClotsAmorphous clots : bladder or prostatic urethral origin

31. Vermiform (wormlike) clots, particularly if associated with flank pain : the upper urinary tract : ureterDuration of HematuriaTransient HematuriaBenign & without any obvious etiology in 39%of young adults 8-9% of adults >50y/o – malignancyPersistent HematuriaDefined as three positive urinalyses, based on a test strip and microscopic examination, over a 2- to 3- week periodMicroscopic – 5% malignancyMacroscopic – 20% malignancy

32. Causes of HematuriaCongenital/inherited

33. PCKD, Hematologic abnormalities

34. Trauma

35. Neoplasm

36. Benign or malignant

37. Infection/Inflammation

38. Metabolic

39. Stone

40. Miscellaneous

41. DrugMost common cause of hematuria 0-20 yr Acute glomerulonephritis Acute UTI Congenital UT anomalies with obstruction 20-40 yr Acute UTI Stones Bladder tumors40-60 yr (men) Bladder tumors Acute UTI Stones40-60 yr (women) Acute UTI Stones Bladder tumors60 yr (men) BPH Bladder tumors Acute UTI60 yr (women) Bladder Tumor Acute UTI

44. Glomerular HematuriaBegin with a thorough history

45. IgA nephropathy (Berger's disease)

46. Familial nephritis or Alport's syndrome

47. Goodpasture's syndrome

48. Systemic Lupus erythematosus

49. PoststreptococcalglomerulonephritisNon-glomerular Hematuria Non-glomerular hematuria or essential hematuria includes primarily urologic rather than nephrologic diseasesCommon causes of essential hematuria include urologic tumors, stones, and UTIs

50. Non-glomerular Hematuria Characterized by circular erythrocytes and the absence of erythrocyte casts

51. An algorithm for the evaluation of nonglomerular hematuria

52. Work –up : Laboratory StudiesUrinalysis

53. Phase contrast microscopy

54. BUN/serum creatinine: Elevated levels of BUN and creatinine suggest significant renal disease as the cause of hematuria