Hematuria

Hematuria

Gross hematuria:
Suspected if a red or brown color change of urine
Intermittent red or brown color urine a/w variety of clinical setting
Medications (phenazopyridine, microbid, NSAID)
Ingestion of beets or certain dyes
Metabolities
Myoglobinuria or hemoglobinuria

Work up
Centrifuge the specimen, Supernatant be tested for heme (hemoglobin or myoglobin) with a urine dipstick.

Causes of heme-negative red urine
Medications
Food dyes
Metabolities
Doxorubicin
Beets (in selected patients)
Bile pigments
Chloroquine
Blackberries
Homogentisic acid
Deferoxamine
Food coloring
Melanin
Ibuprofen
Methemoglobin
Iron sorbitol
Porphyrin
Nitrofurantoin
Tyrosinosis
Phenazopyridine
Urates
Phenolphthalein
Rifampin

Approach to the patient with red or brown urine
Microscopic hematuria:
Major causes of hematuria by age and duration
The evaluation should address the following three questions

1. Are there any clues from the history or physical examination that suggest a particular diagnosis?
2. Does the hematuria represent glomerular or extraglomerular bleeding?
3. Is the hematuria transient or persistent?

Goal is to quickly identify
* Infection
* Kidney stone
* Malignant

History and Physical
Mechanisms by Which Selected Drugs May Cause Hematuria
Hemorrhagic cystitis
Urolithiasis
Carbonic anhydrase inhibitors
Vital sign: BP, T, HR
Abdomen for masses, tenderness (flank, suprapubics), bruits
CVS: irregular irregular
Edema (especially periorbital)
Joint erythema, swelling, warmth
Paleness, jaundice
Careful inspection of external genitalia
Physical Examination Findings and Associated Causes of Hematuria

Physical examination finding
Cause of hematuria
General (systemic) examination
Severe dehydration
Renal vein thrombosis
Peripheral edema
Nephrotic syndrome, vasculitis
Cardiovascular system
Myocardial infarction
Renal artery embolus or thrombus
Atrial fibrillation
Renal artery embolus or thrombus
Hypertension
Glomerulosclerosis with or without proteinuria
Abdomen
Bruit
Arteriovenous fistula
Genitourinary system
Enlarged prostate
Urinary tract infection
Phimosis
Urinary tract infection
Meatal stenosis
Urinary tract infection
Glomerular or Extra Glomerular bleeding?
Microscopic hematuria DDx
Microscopic hematuria DDx
Rare cause of Microscopic Hematuria
Arteriovenous malformations and fistulas
Nutcracker syndrome
Loin pain-hematuria syndrome
Proteinuria
Extraglomerular vs Glomerular in UA
Findings on Microscopy
Transient or persistent hematuria
Exception:
Persistent hematuria
Laboratory Tests (initial work up)
Further Work up
Renal Biopsy
Radiologic and other tests for the evaluation of hematuria
Initial Evaluation of Asymptomatic Microscopic Hematuria
Reference

Hematuria.ppt