Haematuria

January 29, 2018 | Author: Anonymous | Category: Science, Health Science, Urology
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Ken Chow

What is haematuria? 

Macroscopic  Visible haematuria  Pink or red



Microscopic  Gold standard – Microscopy ○ Presence of >3 RBCs per high-powered field  Dipsticks ○ Positive – >1 RBCs per high-powered field ○ Higher false positives

 Symptomatic vs. non-symptomatic ○ Lower Urinary Tract Symptoms (LUTS)  Eg. Dysuria, hesitancy, frequency, urgency

Macroscopic Haematuria

Microscopic Haematuria

Causes 

Renal          



Malignant renal mass Benign renal mass Glomerular bleeding Structural diseases Pyelonephritis Hydronephrosis Hypercalcinuria / Hyperuricosuria Renal vein thrombosis Renal artery embolism Arteriovenous malformation

Ureteric 

   

Malignancy Calculi Strictures Fibroepithelial polyp Fistulas



Bladder   



Malignancy Radiation Cystitis

Prostate/Urethra  

 

Benign prostatic hyperplasia Prostate carcinoma Catheterisation Urethritis

History and Examination 

History  Time course  Infective symptoms  Urinary symptoms  Associated symptoms  Past history  Social history  Family history



Examination  Vital signs  Abdominal  DRE

Workup 

Significant haematuria:  Single episode of macroscopic haematuria  Single episode of symptomatic microscopic haematuria  Persistent non-symptomatic microscopic haematuria



Initial investigations  Exclude transient causes ○ Eg. UTIs, exercise induced, trauma, menstruation ○ Urine cultures

 Serum creatinine and eGFR  Measure for proteinuria ○ Protein:Creatinine ratio (PCR) ○ Albumin:Creatinine ratio (ACR)

 Blood pressure

Urological Referral 

 

All patients with macroscopic haematuria All patients with symptomatic microscopic haematuria All patients with asymptomatic microscopic haematuria who are aged 35 and over

Nephrological Referral 

Consideration of nephrological referral  Declining GFR ○ >10ml/min within the previous 5 years ○ >5ml/min within the last 1 year  Stage 4 or 5 CKD (eGFR
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