Hematuria

1
Hematuria

• Tintinallis Chap. 97

2

• Painful - infection
• Painless neoplastic, hyperplastic, vascular
• Gross urine appears RED lower tract prob.
• Microscopic gt 5 RBCs/hpf kidney dz
• False hematuria urine appears bloody, but
  dipstick results are neg. for blood and no RBCs
  on micro
• Free hgb, myoglobin, porphyrins

3

• Table 97-1 97-2 97-3
• Initial hematuria blood at beginning of
  micturition with subsequent clearing
• Urethral dz.
• Occuring b/w voiding (staining underclothes)
  voiding urine is clear lesions at distal
  urethra or meatus
• Total hematuria blood throughout micturition
  indicates dz of kidneys, ureters or bladder
• Terminal hematuria dz at bladder neck or
  prostatic urethra

4

• Young pts nephrolithiasis or UTI
  glomerulonephritis (poststreptococcal) immune
  complex dz, SCC, HSP Goodpasture syndrome Wilms
  tumor
• Older pts infections or nephrolithiasis renal,
  bladder or prostate CA anticoagulant use AAA
  can expand and erode into urogential tract
  malignant hypertension embolic renal infarction
  renal vein thrombosis
• Pregnancy UTI nephrolithiasis or preeclampsia
• HIV pts viral renal infection
  glomerulonephritis UTI chlamydial and
  gonococcal urethritis chronic Hep B infxn
  neurogenic bladder thrombocytopenia
  uroepithelial Kaposi sarcoma urethral trauma

5

• Diagnosis
• H P
• Clean catch midstream urine for U/A
• Cath urine if woman has vag. d/c, menstrual or
  vag. Bleeding (cath urine will rarely exceed 3
  RBCs/hpf)
• Can screen with dipstick but false negs/pos may
  result
• Abnormal RBC morphologic characteristics, RBC
  casts proteinuria suggest glomerular source
• If normal RBCs then infection probable
• Imaging (IVP, CT, renal US)

6

• Gross hematuria in blunt or penetrating trauma to
  abd, flank, or back requires aggressive approach
  to dx
• Tx directed at cause
• UTI axbx
• Nephrolithiasis hydration analgesics
• Systemic dz directed at cause
• Discharge pts that have min. or no sxs, tolerate
  PO, and have no comorbid conditions
• Also should not have significant anemia or renal
  insufficiency

7

• May need to use 3-way foley to irrigate bladder
  until clear before d/c pt
• Prevent clots in the urethra that would cause
  bladder outlet obstruction
• Admit pts
• Intractable pain
• Do not tolerate PO
• Significant comorbid illnesses
• Bladder outlet obstruction
• Hemodynamic instability
• Life-threatening cause of hematuria
• New dx of glomerulonephritis

8

• Dont forget in pregnant pts that this could be a
  sign of preeclampsia, pyelonephritis, or
  obstructing nephrolithiasis
• Consult OB and admit

9
Hematospermia

• Trauma
• Other injury (i.e. tumor w/ erosion)
• Inflammation (common in men lt40 y. o.)
• Infection (common in men lt40 y. o.)
• Instrumentation of urinary tract
• Radiation therapy
• Prostate tumors or BPH (men gt 40 y. o.)
• most common

10

• Testicle tumors, vascular abnormalities, cyts
• Systemic factors hemophilia, coagulopathies,
  oral anticoagulants, hypertension, leukemia,
  lymphoma, scurvy
• H P
• U/A
• Tx underlying cause (if one identified)
• Infxn axbx
• Urologist F/U (esp. if gt 40 y.o.)