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Hematuria for undergraduates


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Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
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Hematuria for undergraduates

  1. 1. Urology DepartmentUnder-graduate coursesHematuria M.A.Wadood Aref
  2. 2. DEFINITIONMore than three red blood cells are found incentrifuged urine per high-power fieldmicroscopy ( > 3 RBC/HP).Normal urine:no red blood cell or less than 3 red blood cell
  3. 3. Classification According to the amount of RBC in the urine, hematuria can be classified as:• gross hematuria (visible) • microscopic hematuria tea-colored, cola-colored, pink or normal colour with eyes even red
  4. 4. ClassificationAnother classification by Timing (when it occursduring urination), which may indicate the location ofthe problem.Initial hematuria: Onset of urination – urethra.Total hematuria: Throughout urination – bladder,ureter, or kidneys.Terminal hematuria: End of urination – bladder orprostate (men).
  5. 5. ETIOLOGY Diseases of the urinary system— the most common causea- Glomerularb- Interstitialc- Uroepitheliumd- Vascular
  6. 6. ETIOLOGYGlomerular IgA nehropathy 1ry and 2ry glomerulonephritisInterstitial Allergic interstitial nephritis Analgesic nephropathy Renal cystic diseases Acute pyelonephritis Tuberculosis Renal allograft rejection
  7. 7. ETIOLOGYUroepithelium Malignancy Trauma Papillary Necrosis Cystitis/Urethritis/Prostatitis Parasitic Diseases (Schistosomiasis) StonesVascular Arterial emboli or thrombosis Arteriovenous fistulae Renal vein thrombosis
  8. 8.  System disorders (less common) a. Hematological disorders aplastic anemia - leukemia - hemophilia - ITP (idiopathy thrombocytopenic purpura) b. Infection infective endocarditis - septicemia - epidemic hemorrhagic fever - scarlet fever - filariasisc. Connective tissue diseases SLE - polyarteritis nodosad. Cariovascular diseases hypertensive nephropathy- chronic heart failure - renal artery sclerosise. Endocrine and metabolism diseases gout - diabetes mellitus
  9. 9.  Diseases of adjacent organs to urinary tract appendicitis carcinoma of the rectum carcinoma of the colon uterocervical cancer Drug and chemical agents anticogulation cyclophosphamide miscellaneous exercise induced hematuria
  10. 10. DIFFERENTIAL DIAGNOSIS• Polluted urine: menstruation• Drug and food: Rifampicin, Nitrofurantoin, sulfonamides, adriamycin.• Porphyria: porphyrin in urine (+)• Hemoglobinuria (hemolysis)• Myoglobinuria
  11. 11. ACCOMPANIED SYMPTOMS• Hematuria with renal colic renal stone, ureteric stone.• Hematuria with urinary frequency,urgency and dysuria bladder or lower urinary tract (TB or tumor) If accompanied by high spiking fever, chill and loin pain: pyelonephritis
  12. 12. ACCOMPANIED SYMPTOMS• Hematuria with edema and hypertension glomerulonephritis - hypertensive nephropathy• Hematuria with mass in the kidney neoplasm - hereditary polycystic kidney• Hematuria with hemorrhage in skin and mucosa hematological disorders - infectious diseases• Hematuria with chyluria filariasis
  13. 13. Workup of Hematuria• Investigation are crucial to exclude serious underlying conditions, especially urinary tract neoplasm.• Patients on anticoagulants should also be investigated. Anticoagulants are more likely to provoke rather than be the cause of hematuria.• Full urological History• Physical exam: of urinary tract, abdomen, pelvis, genitals, and rectum. ©
  14. 14. Workup of Hematuria - Lab• Urinalysis & 3 glass test: for protein, RBCs, RBC casts, bacteria• Phase contrast microscopy: for RBCs morphology• Cytology: for exfoliated malignant cells.• Creatinine ©
  15. 15. Workup of Hematuria – Radiology & procedures• Imaging studies:  Ultrasound: primary investigation  IVU: standard investigation (old).  CT urography: now replaces IVU.  MRI.  Retrograde pyelography.• Renal biopsy: in nephrological cases• Cystoscopy ©
  16. 16. LABORATORY TESTS Three-glass testMethod: collecting the three stages of urine of a patient during micturitionResult: the initial specimen containing RBC—the urethra. the last specimen containing RBC—the bladder. neck and trianglar area, post. Urethra. all the specimens containing RBC—upper urinary tract, bladder.
  17. 17. LABORATORY TESTSPhase-contrast microscopy to distinguish glomerular from post glomerular bleeding• Post glomerular bleeding: normal size and shape of RBC• Glomerular bleeding: dysmorphic RBC (acanthocyte)
  18. 18. LABORATORY TESTSExample Of Phase-contrast Microscopy Test Non-Glomerular Glomerular (dysmorphic RBCs)
  19. 19. HEMATURIA Algorithm proteinuria (>500mg/24h) (-) Dysmorphic RBC or RBC casts (+) (+)Pyuria,WBC casts urine culture eosinophils (-) serologic and hematologic evaluation: blood culture,Hb electrophoresis, urine cytology, anti-GBM Ab, ANCA,UA of family member, 24h urinary complement, cryoglobulincalcium/uric acid HBV,HCV,VDRL,HIV, (-) As indicated: ASLO (+)IVP+/-renal retrogradeultrasound pyelography or renal biopsy (-) arteriogram of cyst (+) aspirationcystoscopy (-) biopsy ANCA:antineutrophil cytoplasmic (+) antibody, VDRL:venereal dis. CT scan research laboratory, ASLO: (-) open renal biopsy antisteptolysin O, IVP: intravenous follow pyelography
  20. 20. Thank You