Hematuria - Revision history

Aidan: /* Background */

2021-03-13T18:01:59Z

Background

← Older revision		Revision as of 18:01, 13 March 2021
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	== Background ==		==Background==

			*Microscopic hematuria: the presence of blood on urinalysis
	* ~~Presence~~ of visible blood in the urine		*Macroscopic or gross hematuria: the presence of visible blood in the urine

	=== Etiologies ===		===Etiologies===

	* Renal:		*Renal:
	** Benign renal mass, including [[angiomyolipoma]], [[oncocytoma]], [[renal abscess]]		**Benign renal mass, including [[angiomyolipoma]], [[oncocytoma]], [[renal abscess]]
	** Malignant renal mass, including [[renal cell carcinoma]], [[transitional cell carcinoma]]		**Malignant renal mass, including [[renal cell carcinoma]], [[transitional cell carcinoma]]
	** Glomerular bleeding from [[IgA nephropathy]], [[thin basement membrane disease]], [[Alport syndrome]]		**Glomerular bleeding from [[IgA nephropathy]], [[thin basement membrane disease]], [[Alport syndrome]]
	** Structural disease, from polycystic kidney disease, medullary sponge kidney		**Structural disease, from polycystic kidney disease, medullary sponge kidney
	** [[Pyelonephritis]]		**[[Pyelonephritis]]
	** [[Hydronephrosis]] or distension		**[[Hydronephrosis]] or distension
	** [[Hypercalciuria]] or [[hyperuricosuria]]		**[[Hypercalciuria]] or [[hyperuricosuria]]
	** [[Malignant hypertension]]		**[[Malignant hypertension]]
	** [[Renal vein thrombus]] or [[renal artery embolism]]		**[[Renal vein thrombus]] or [[renal artery embolism]]
	** [[Arteriovenous malformation]]		**[[Arteriovenous malformation]]
	** [[Papillary necrosis]]		**[[Papillary necrosis]]
	* Ureteric: malignancy, [[ureteric stone]], stricture, [[fibroepithelial polyp]], post-surgical changes including [[ureteroiliac fistula]]		*Ureteric: malignancy, [[ureteric stone]], stricture, [[fibroepithelial polyp]], post-surgical changes including [[ureteroiliac fistula]]
	* Bladder:		*Bladder:
	** Malignany, including [[transitional cell carcinoma]] and [[squamous cell carcinoma]]		**Malignany, including [[transitional cell carcinoma]] and [[squamous cell carcinoma]]
	** Radiation		**Radiation
	** [[Cystitis]]		**[[Cystitis]]
	** [[Bladder stones]]		**[[Bladder stones]]
	* Urethra and prostate:		*Urethra and prostate:
	** [[Benign prostatic hypertrophy]]		**[[Benign prostatic hypertrophy]]
	** [[Prostate cancer]]		**[[Prostate cancer]]
	** Prostatic procedures, including biopsy, [[transurethral resection of the prostate]]		**Prostatic procedures, including biopsy, [[transurethral resection of the prostate]]
	** Traumatic catheterization		**Traumatic catheterization
	** Urethritis		**Urethritis
	** [[Urethral diverticulum]]		**[[Urethral diverticulum]]

	== Differential Diagnosis ==		==Differential Diagnosis==

		⚫	* Always consider [[menstruation]]
⚫	* Urine with the appearance of hematuria but without hemoglobin or myoglobin includes:
⚫	** Medications: [[doxorubicin]], [[chloroquine]], [[deferoxamine]], [[ibuprofen]], [[iron sorbitol]], [[nitrofurantoin]], [[phenazopyridine]], [[phenolphthalein]], [[rifampin]]
⚫	** Food: beets, blackberries, food colouring
⚫	** Metabolic causes: bile pigments, homogentisic acid, melanin, methemoglobin, [[porphyria]], tyrosinosis, urates
⚫	* ~~Also~~ consider menstruation

			=== Macroscopic Hematuria ===
⚫	== Investigations ==

		⚫	*Urine with the appearance of hematuria but without hemoglobin or myoglobin includes:
⚫	* Confirm hematuria
		⚫	**Medications: [[doxorubicin]], [[chloroquine]], [[deferoxamine]], [[ibuprofen]], [[iron sorbitol]], [[nitrofurantoin]], [[phenazopyridine]], [[phenolphthalein]], [[rifampin]]
⚫	* Consider [[nephrolithiasis]] based on clinical exam with or without imaging
		⚫	**Food: beets, blackberries, food colouring
⚫	** Treat if identified
		⚫	**Metabolic causes: bile pigments, homogentisic acid, melanin, methemoglobin, [[porphyria]], tyrosinosis, urates
⚫	* Consider [[urinary tract infection]], based on clinical exam and urinalysis

⚫	** Treat if identified, and repeat urinalysis following resolution of infection to assess for persistent hematuria
		⚫	==Investigations==
⚫	* Assess for glomerular bleeding with urinary and serum albumin, serum creatinine, urine microscopy for dysmorphic RBCs, RBC casts, or WBC casts, and assess for hypertension or edema

⚫	** Refer to Nephrology if present
		⚫	*Confirm hematuria
⚫	* Assess risk of structural cause, including age >35 years, smoking, prior macroscopic hematuria, exposure to benzenes or aromatic amines, heavy NSAID use, prior urologic disorder, lower urinary tract symptoms, recurrent UTIs, prior pelvic irradiation, prior alkylating agents such as [[cyclophosphamide]], or prior [[aristolochic acid]]
		⚫	*Consider [[nephrolithiasis]] based on clinical exam with or without imaging
⚫	** CT abdomen/pelvis for urography (if not pregnant)
		⚫	**Treat if identified
⚫	** Urology to see for cystoscopy
		⚫	*Consider [[urinary tract infection]], based on clinical exam and urinalysis
⚫	* Otherwise, consider ultrasound of kidney and bladders +/- cystoscopy
		⚫	**Treat if identified, and repeat urinalysis following resolution of infection to assess for persistent hematuria
		⚫	*Assess for glomerular bleeding with urinary and serum albumin, serum creatinine, urine microscopy for dysmorphic RBCs, RBC casts, or WBC casts, and assess for hypertension or edema
		⚫	**Refer to Nephrology if present
		⚫	*Assess risk of structural cause, including age >35 years, smoking, prior macroscopic hematuria, exposure to benzenes or aromatic amines, heavy NSAID use, prior urologic disorder, lower urinary tract symptoms, recurrent UTIs, prior pelvic irradiation, prior alkylating agents such as [[cyclophosphamide]], or prior [[aristolochic acid]]
		⚫	**CT abdomen/pelvis for urography (if not pregnant)
		⚫	**Urology to see for cystoscopy
		⚫	*Otherwise, consider ultrasound of kidney and bladders +/- cystoscopy

Aidan: Aidan moved page Gross hematuria to Hematuria

2021-03-13T18:00:38Z

Aidan moved page Gross hematuria to Hematuria

← Older revision	Revision as of 18:00, 13 March 2021
(No difference)

Aidan: Created page with "== Background == * Presence of visible blood in the urine === Etiologies === * Renal: ** Benign renal mass, including angiomyolipoma, oncocytoma, renal abscess..."

2021-03-13T18:00:17Z

Created page with "== Background == * Presence of visible blood in the urine === Etiologies === * Renal: ** Benign renal mass, including angiomyolipoma, oncocytoma, renal abscess..."

New page

== Background ==

* Presence of visible blood in the urine

=== Etiologies ===

* Renal:
** Benign renal mass, including [[angiomyolipoma]], [[oncocytoma]], [[renal abscess]]
** Malignant renal mass, including [[renal cell carcinoma]], [[transitional cell carcinoma]]
** Glomerular bleeding from [[IgA nephropathy]], [[thin basement membrane disease]], [[Alport syndrome]]
** Structural disease, from polycystic kidney disease, medullary sponge kidney
** [[Pyelonephritis]]
** [[Hydronephrosis]] or distension
** [[Hypercalciuria]] or [[hyperuricosuria]]
** [[Malignant hypertension]]
** [[Renal vein thrombus]] or [[renal artery embolism]]
** [[Arteriovenous malformation]]
** [[Papillary necrosis]]
* Ureteric: malignancy, [[ureteric stone]], stricture, [[fibroepithelial polyp]], post-surgical changes including [[ureteroiliac fistula]]
* Bladder:
** Malignany, including [[transitional cell carcinoma]] and [[squamous cell carcinoma]]
** Radiation
** [[Cystitis]]
** [[Bladder stones]]
* Urethra and prostate:
** [[Benign prostatic hypertrophy]]
** [[Prostate cancer]]
** Prostatic procedures, including biopsy, [[transurethral resection of the prostate]]
** Traumatic catheterization
** Urethritis
** [[Urethral diverticulum]]

== Differential Diagnosis ==

* Urine with the appearance of hematuria but without hemoglobin or myoglobin includes:
** Medications: [[doxorubicin]], [[chloroquine]], [[deferoxamine]], [[ibuprofen]], [[iron sorbitol]], [[nitrofurantoin]], [[phenazopyridine]], [[phenolphthalein]], [[rifampin]]
** Food: beets, blackberries, food colouring
** Metabolic causes: bile pigments, homogentisic acid, melanin, methemoglobin, [[porphyria]], tyrosinosis, urates
* Also consider menstruation

== Investigations ==

* Confirm hematuria
* Consider [[nephrolithiasis]] based on clinical exam with or without imaging
** Treat if identified
* Consider [[urinary tract infection]], based on clinical exam and urinalysis
** Treat if identified, and repeat urinalysis following resolution of infection to assess for persistent hematuria
* Assess for glomerular bleeding with urinary and serum albumin, serum creatinine, urine microscopy for dysmorphic RBCs, RBC casts, or WBC casts, and assess for hypertension or edema
** Refer to Nephrology if present
* Assess risk of structural cause, including age >35 years, smoking, prior macroscopic hematuria, exposure to benzenes or aromatic amines, heavy NSAID use, prior urologic disorder, lower urinary tract symptoms, recurrent UTIs, prior pelvic irradiation, prior alkylating agents such as [[cyclophosphamide]], or prior [[aristolochic acid]]
** CT abdomen/pelvis for urography (if not pregnant)
** Urology to see for cystoscopy
* Otherwise, consider ultrasound of kidney and bladders +/- cystoscopy