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Case Presentation

Hematuria. DOMMRWeek of 12/1/2008Rozina Mithani. Learning Objectives. Understand the Initial approach

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Case Presentation

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    1. Case Presentation 62 y/o M with h/o CAD s/p PCI (on ASA/plavix), BPH s/p TURP, DM, tobacco abuse presents with hematuria x 4d, no dysuria, no f/c, no flank pain. PE & Labs: unremarkable Cystoscopy: Anterior urethra with a small stricture. Normal posterior urethra Moderately obstructing prostate, friable mucosa Bladder with bullous edema on the bladder floor consistent with recent foley catheter removal. Remainder of bladder with normal mucosa, no suspicious erythematous patches, masses or lesions. Bilateral UOs normal appearing.

    2. Hematuria DOMMR Week of 12/1/2008 Rozina Mithani

    3. Learning Objectives Understand the Initial approach & Evaluation Differentiate Glomerular vs Extraglomerular causes Identify the Imaging modality of choice

    4. The Evaluation History Often clues that point to a specific diagnosis Labs BMP: evaluate kidney function U/A: may include urine cytology Imaging CTU vs. U/S Cystoscopy

    5. Clues on History Pyuria + Dysuria UTI vs. Malignancy Recent URI Postinfectious GN or IgA nephropathy Unilateral flank pain ? groin Obstruction (i.e. calculus, blood clot) Loin pain-hematuria syndrome Hesitancy & Dribbling BPH (inc vasc/new vessels can be fragile) Cyclic hematuria in women Endometriosis of the urinary tract Sterile pyuria Renal TB Analgesic nephropathy, Interstitial diseases FHx of renal disease Hereditary Nephritis, PCKD, Sickle cell disease Bleeding d/o or Uncontrolled Anticoagulant tx Shouldnt assume hematuria alone can be explained by chronic warfarin therapy Medications that might cause nephritis Recent vigorous exercise or trauma Exercise-induced hematuria AA pts: screen for sickle cell ? papillary necrosis & hematuria Travel or residence in areas endemic for Schistosoma haematobium, or TB

    6. Urinalysis Gross Hematuria Color change doesnt = Degree of Blood Loss 1ml can induce visible color change Clots = LUTS Microscopic Hematuria >2 RBCs per hpf

    8. Urine Studies Urine Sediment: RBCs/mL of uncentrifuged urine = Gold Standard for microscopic hematuria Dipstick: 1-2 RBCs/hpf Always confirm with microscopic more false positives 2/2 Semen Alkaline urine (pH >9) Contamination w/agents used to clean the perineum Myoglobinuria

    9. Hematuria is a Symptom Inflammation/Infection - prostate or bladder Nephrolithiasis Malignancy kidney or urinary tract BPH

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