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Haematuria (Aetiology (Autoimmune Post-strep GN IgA nephropathy HSP …
Haematuria
Aetiology
Autoimmune
Post-strep GN
IgA nephropathy
HSP
PAN
Goodpasture's
Neoplastic
Cysts
BPH
Cancers (renal, Wilms, ureter,
bladder, prostate, endometrial)
Trauma
Blunt/penetrating
Exercise
FB, catheter
Strictures
Obstruction
Caliculi
Haematological
Sickle cell disease
Coagulopathy
Infection
Urethritis, cystitis, pyelonephritis, prostatitis
Renal tract TB
Drugs
Anticoagulants
NSAIDs
Cyclophosphamide
Some abx e.g. cephalosporins
Clinical
presentation
Bloody urine
Asymptomatic
Pain
Fever
Differentials
Metabolic
Porphyria
Bilirubinaemia
Myoglobulinuria
Haemaglobinuria
Idiopathic
Food e.g. beetroot
Drugs
Rifamipicin
Nitrifurantoin
Senna
Endocrine
Menses
Management
Conservative
Information, advice, support
Identify and manage cause
Monitoring (annual BP, GFR, ACR, urine dip)
Urgent (2 week) referral
Suspected renal/bladder, prostate
or endometrial cancer
Non-urgent referral
Urology: any VH or sNVH,
persistant aNVH in >40y
Renal: VH if <40y cola urine and recent infection, aNVH with BP>140/90, GFR<60, ACR>30
Haematuria clinic
Bloods (FBC, U+E, PSA)
Urine (dipstick, MCS)
USS KUB, cystoscopy
Diagnosis
Examination
Abdo exam
Fluid status
Genital exam
If ?menstrual disorder
DRE
If indicated (prostate
Investigations
Bedside
Obs (any HTN, fever)
Bloods
FBC (anaemia), CRP (infection),
U+, GFR, Cr (renal disease), LFTs (CLD), clotting,
glucose (DM, sepsis)
PSA (BPH, cancer)
Immune screen (ANA, ANCA)
Anti-steptoysin Abs (strep)
Imaging
USS KUM: masses, structural deformity
Cystoscopy: tumours
CT/MRI abdo/pelvic: staging
CT angiography: vasculature
Retrograde pyelography: obstruction
Urine
Dipstick (+++ blood, may have leukocytes, nitrates, protein)
MCS, casts, cytology, ACR
Biopsy
If warranted
History
PMH
Known medical conditions
DM, PCKD
Autoimmune disease
FH
Renal disease
Autoimmune disease
PC/HPC
Bloody urine, pain, fever, dysuria, stranguary,
hesitancy, frequency, nocturia
Red flags: weight loss, fever, night sweats, abdominal mass
DH
Meds, allergies
SH
Living arrangements, occupation (rubber, dyes),
school, smoking, alcohol, diet, travel (schistosomiasis)
Definitions
Non-visible haematuria
Non visible blood in the urine
Symptomatic or non-symptomatic
Significant haematuria
One episode of VH, or sVH without clear cause
Persistent nVH without clear cause
Visible haematuria
Visible blood in the urine
Epidemiology
Common
VH associated with malignancy