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Patho L7: Hematuria and Renal stone - Coggle Diagram

- - - - visible to naked eye
      - Colour: pink,red, brownish red, tea-coloured
        *does not reflect degree of blood loss
      - False gross hematuria
        
        Endogenous substance: myoglobin, bilirubin, porphyrin
        
        Food: beetroot, blackberries, rhubard, fava been, artificial food colouring
        
        Drugs: Rifampin, Phenazopyridine, Senna, Chloroquine, Primaquine, Metronidazole, Nitrofurantoin
    - - not visible to naked eye
        
        detected by mic examination
      - 3 or > RBC per high power field (hpf) in a properly collected urinary specimen in the absence of an obvious benign cause
        
        benign cause: menstruation, vigorous excercise, viral illness, trauma, infection, recent urological procedure
      - Urine dipstrick cannot determine mic, hematuria even tho it is positive
  - - - Rise from glomeruli
      - Causes
        
        IgA nephropathy
        
        Thin basement membrane disease
        
        Hereditary nephritis (Alport syndrome)
        
        Post-Streptococcus glomerulonephritis
        
        Goodpasture syndrome
        
        Lupus nephritis
        
        Henoch Schonlein purpura
        
        Renal vasculitis
        
        Membranoproliferative glomerulonephritis
      - How to know?
        
        presence of dysmorphic RBC (misshapen, fragmented)
        
        Presence of RBC cast - RBC clumped to form a strip
        
        Presence of proteinuria
      - Pathophysiology
        
        infalmmation (acquired cause) or immunological process (acquired)
        
        disruption in the integrity of glomerular basement membrane
        
        Narrow passage in the GBM cause damage and dysmorphic RBC
        
        RBC trapped in Tamm-Horsfall protein (protein in the tubule) and manifest as RBC cast (long strip shape following tubule shape)
    - - Rise from:
        
        Upper UT (kidney, ureter)
        
        Lower UT (bladder, urethra)
      - Causes
        
        Upper tract
        
        Renal stones
        
        Pyelonephritis
        
        Polycystic kidney disease
        
        Renal cell carcinoma
        
        Transitional cell carcinoma
        
        Urinary obstruction
        
        Trauma
        
        Lower tract
        
        Acute cystitis
        
        Urinary stone
        
        Transitional cell carcinoma
        
        Benign prostatic hyperplasia
        
        Trauma/ Instrumentation
        
        Strenous exercise
        
        Spurious hematuria
        
        Others
        
        Bleeding disorders, anticoagulant
      - How to know?
        
        Monomorphic RBC: