hematuria - a diagnostic approach
DESCRIPTION
Hematuria - A Diagnostic Approach. Douglas Stahura D.O. GVH 8/24/00. Goals. Epidemiology Evaluation Differential Diagnosis Case Reports. Hematuria - Epidemiology. Definitions Macroscopic - pink, red, or tea colored Microscopic - >4 RBC’s per hpf of spun urine sediment Prevalence - PowerPoint PPT PresentationTRANSCRIPT
Hematuria - A Diagnostic Approach
Douglas Stahura D.O.
GVH
8/24/00
Goals
• Epidemiology
• Evaluation
• Differential Diagnosis
• Case Reports
Hematuria - Epidemiology• Definitions
– Macroscopic - pink, red, or tea colored– Microscopic - >4 RBC’s per hpf of spun
urine sediment
• Prevalence– School aged - 4% (always check a 2nd
specimen)– >35 y/o - 13%– PPV low, most useful in elderly men
Hematuria - Epidemiology
• Specific– Glomerular causes -
– Predominate in children and young adults– >40 y/o only 5% of cases
– Neoplasm– >40 y/o, Urinary tract 15-20% of cases– Children: Wilm’s tumor,
Rhabdomyosarcoma of bladder
Hematuria - Evaluation
• History
• Physical
• Urinalysis
Hematuria - Evaluation
Hematuria - Evaluation• Urinalysis
– Proteinuria - indicator of glomerular disease
• can be up to 500 mg/24 hr in gross hematuria
– RBC cast - must look at urine with your own eyes
– Pyuria - look for UTI/STD– Crystals– Dysmorphic RBC’s
Hematuria - Evaluation
• Glomerular Dx– Renal bx– C3,C4, CH50– ASO, ANA,
cryoglobulin– ANCA, anti-GBM– SPEP/UPEP, Ig– audio/eye– sickle screen
• Non-glomerular Dx– culture– Chlamydia, N.
gonorrhea– renal U/S– Flat plate Abd– IVP– Cystoscopy
Hematuria - Cases
• Case 1– 22 y/o WF gross hematuria x2 days– mother of 2: 4y/o, 4mo– works 12 hr shift as waitress, 3 in 4 d– monagamous x 2 years– +/- dysuria, +/- flank pain– PE - no trauma– UA - pro 2+, WBC 5-10/hpf, Bac 1+
Hematuria - Cases
• Case 2– 65 y/o WM gross hematuria x6 weeks– denies pain, freq, hesitancy– 50 pack-yr cigarette– PE - unremarkable– UA - Pro 2+, WBC none, Bac none
Hematuria - Cases
• Case 3– 44 y/o male gross hematuria and episodic
flank pain radiating to groin on left side. Unable to find comfortable position.
– PE - uncomfortable, distressed, restless– UA - gross hematuria
Hematuria - Cases
• Case 4– 75 y/o male with microscopic hematuria on
screening. Hx of hesitancy and weakened urinary stream.
– PE - 150/85, enlarged prostate without nodularity/tenderness
– UA - 8-10 RBC’s/hpf
Hematuria - Cases
• Case 5– 41 y/o male with 2 episodes of gross
hematuria over last 24 hours.– Completed AF marathon yesterday– PE - unremarkable– UA - 15-20 RBC’s/hpf
Hematuria - Cases• Case 6
– 52 y/o female with 4 day hx of upper respiratory sx of cough, fever, scant sputum production.
– Over 24h, progresses to Acute respiratory failure
– PE - on vent, febrile, normotensive, oliguric, bloody sputum, anemic.
– UA - microscopic hematuria, + Legionella antigen, occ dysmorphic RBC’s, BUN/Cr = 54/5.5 CXR - B/L patchy infiltrates
Hematuria - Cases• Case 7
– 39 y/o male construction worker presents to ED with L arm swelling and tenderness. Denies trauma. + warmth/erythema x4d
– Teated with Keflex x 7d. – 10 d post ATBX, notices blood in urine– PE - L arm nl, 150/85, NAD– UA - 5-10 RBC/hpf, occ dysmorphic rbc, no
casts, bac, WBC reported.
Hematuria - Cases• Case 8
– 20 y/o Japanese exchange student presents with URI sx x1 day. Cough, low grade fever, headache, myalgias. On day two, notices blood in urine.
– PE - t=99.2, cough, no sputum, minimal distress.
– UA - RBC TNTC, Pro 4+, no casts, no bac.