| How is hematuria classified? | Hematuria may be classified according to its visibility and timing during the urinary stream
a/ Gross hematuria : seen by naked eye – Can be total, initial or terminal depending on the source
b/Microscopic hematuria : not visible to the naked eye and it is a sign rather than a symptom; a laboratory diagnosis defined as the presence of red blood cells on microscopic examination of urine – three or more RBCs/HPF |
| Why is it important to evaluate MH? | The evaluation of patients with MH yields a diagnosis of malignancy in 1.8% to 4.3% of case
The diagnosis of the malignancy will increase with the levels of RBC in the urinalysis |
| What is DD of asymptomatic MH? | Neoplasm : bladder , kidney , ureter , urethral , prostate
Infection
Calculus
BPH
Medical renal disease
Congenital anatomical abnormality |
| What are risk factors for UT malignancies in pt w/ MH? | . |
| How is evaluation of pt w/microhematuria? | Hx, PE, renal function test, UT imaging for all pt.
Kidney and bladder US ; initial test if RBC <15
CT urogram (best modality evaluated hematuria)
Light cystoscopy (for asymptomatic MH 35 yrs or older w/risk factor for malignancy)
Urine cytology (not indicated initially)
Patients with a negative complete evaluation can be released from care if subsequent urinalyses confirm resolution of MH.
Re-evaluation should be considered in patients with persistent/recurrent MH and those with an incomplete initial evaluation |
| What is gross hematuria? | Among patients with GH, 50% have been found to have a demonstrable cause, with 20% to 25% found to have a urologic malignancy, most commonly bladder cancer and kidney cancer |
| How is hematuria from prostatic origin? | BPH represents the most common cause of GH in men older than 60 years.
• 5α-Reductase inhibitors may be used for BPH-related GH.
• Androgen deprivation may be effective for patients with locally advanced prostate cancer with GH.
• Angioembolization and/or urinary diversion represent salvage options for management for patients with refractory hematuria, pending clinical status. |
| How is hemorrhagic cystitis? | Most common GH LUT.
Intractable hematuria localizing to the bladder
chemotherapeutic agents have been linked to the development of hemorrhagic cystitis through exposure of the metabolite acrolein to the urothelium.
• Alum may be used as a first-line intravesical therapy for hemorrhagic cystitis in patients without renal dysfunction.
• Formalin is a highly effective form of intravesical therapy for hemorrhagic cystitis. A cystogram should be obtained before therapy to ensure no vesicoureteral reflux.
• HBO2 ( hyperbaric Oxygen)has been associated with response rates of 80% to 100% for patients with hemorrhagic cystitis. |
| How is urethral bleeding? | • Urethral bleeding should be suspected with blood at the meatus and/or initial hematuria.
• A concern for traumatic urethral injury should prompt retrograde urethrogram. |
| What are hematuria originating from UUT? | Renal glomerular diseases
Renal tubulointerstitial diseases
Vasculitis i.e Henoch-Schönlein purpura
Infection
Ureteral or UPJ Obstruction
Nephrolithiasis
Malignancy
Vascular diseases( Arteriovenous malformations , renal artery aneurysm
Trauma |
| What is GH originating from UUT findings? | Kidney diseases
Urinary findings suggestive of a glomerular causes on urinalysis include:
1- the presence of RBC casts
2-dysmorphic RBCs
3-and proteinuria on the urinalysis |
| How is evaluation of GH? | Patients presenting with GH in the absence of antecedent trauma or culture-documented UTI should be evaluated with
1- urine cytologic examination
2-cystoscopy
3- upper tract imaging, preferably CT urogram |
