HAEMATURIA

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HAEMATURIA

• SAIMA USMAN

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HAEMATURIA

• Common finding
• Incidental
• DEFINING HAEMATURIA
• Visible haematuria
• Non visible haematuria (dipstick and microscopic)

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Indication for urine dipstik testing

• Lower urinary tract symptoms
• Upper urinary tract symptoms
• Diagnosis of hypertension
• Diabetes(at least annually)
• Newly detected renal dysfunction(e GFRlt60ml/min)
• Suspected multisystem disease with possible renal
  involvement.

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Innocent haematuria

• Haemoglobinuria
• Myoglobinuria
• Menstruation
• Sexual intercourse
• Acute intermittent porphyria
• Food beet root, black berries, rhubarb
• Drugs nitrofurantoin,senna,rifampicin,phenolphtha
  lein,chloroquine,doxorubicin
• Chronic lead or mercury poisoning

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HAEMATURIA

• UTI typically causes non visible transient
  haematuria and if simple doesn't require further
  investigations.
• Presence of bacterial peroxidases can cause a
  false positive dipstick test
• Dipstick testing for blood is less sensitive in
  the urine with high specific gravity and heavy
  proteinuria

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CAUSES OF HAEMATURIA

• PRE RENAL CAUSES
• Bleeding diathesis
• Atrial fibrillation
• Infective endocarditis
• Scurvy

• Purpura
• Leukaemia
• Thrombocytopenia
• haemophilia

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CAUSES OF HAEMATURIA

• RENAL CAUSES
• NEPHROLOGICAL
• IgA nephropathy
• Glomerulonephritis
• Polyarteritis nodosa
• Good pastures syndrome
• Acute pyelonephritis

• Polycystic kidney disease
• Haemolytic uremic syndrome
• Alports syndrome

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Causes of haematuria

• UROLOGICAL

• GENERALIZED

• Malignancy
• Benign tumour
• Trauma
• Calculus
• PKD
• Renal vasculature problems
• Medullary sponge kidney

• Renal toxins
• SLE

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CAUSES OF HEMATURIA

• POST RENAL CAUSES
• URETERIC
• Calculus
• Carcinoma
• Papilloma
• schistosomiasis

• BLADDER/PROSTATIC
• Tumour
• BPH
• Prostatic cancer
• Calculus
• Cystitis
• Injury/FB
• Purpura
• Schistosomiasis

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CAUSES OF HAEMATURIA

• URETHRAL
• Acute urethritis
• Calculus
• Injury
• Carcinoma
• Papilloma
• Urethral meatal ulcer
• F.B

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Approach to haematuria

• Thorough history including
• Urinary symptoms
• Recent history (trauma/muscle injury/causes of
  factitious haematuria/exercise/foreign travel)
• Systemic features (fever, weight loss) other
  symptoms(bleeding,bruising)
• Co-morbidity
• Drug history
• Occupation
• Family history

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EXAMINATION
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INVESTIGATING HAEMATURIA
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INVESTIGATING HAEMATURIA
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REFERRAL CRITERIA

• URGENT (2 WEEKS WAIT) REFERRAL (urology)
• Visible haematuria (unless GN is suspected)
• Haematuria with recurrent or persistent UTI in
  adult over 40 years
• Persistent non visible haematuria in adult over
  50 years.
• Abdominal mass identified clinically or on
  imaging that is thought to arise from urinary
  tract.

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REFERRAL CRITERIA

• UROLOGY
• All patient with symptomatic non-visible
  haematuria who don't meet the criteria for urgent
  referral.
• Patient with persistent asymptomatic non-visible
  haematuria age 40-50 years.

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REFERRAL CRITERIA

• NEPHROLOGY
• Evidence of decline of eGFR (by gt10ml/min in
  previous 5 years or by gt5ml/min in the last
  year).
• Stage 4 or 5 kidney disease.
• Significant proteinuria (ACR 30 or more or PCR 50
  or more).
• Isolated haematuria with hypertension in those
  under 40 years.
• Visible haematuria coinciding with intercurrent
  ,usually upper respiratory, infection.

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If no cause established

• Annual assessment(while haematuria persists)of
  BP, eGFR and ACR/PCR
• Re referral to urology if
• Significant or increasing proteinuria(ACRgt30 or
  PCRgt50)
• Estimated GFR lt30ml/min(Confirmed on at least 2
  readings and without an identifiable reversible
  cause)
• Deteriorating eGFR(gt5ml/min in 1 year orgt10ml/min
  in 5 years.

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THANK YOU!

• .