3 Hematuria - Epidemiology DefinitionsMacroscopic - pink, red, or tea coloredMicroscopic - >4 RBC’s per hpf of spun urine sedimentPrevalenceSchool aged - 4% (always check a 2nd specimen)>35 y/o - 13%PPV low, most useful in elderly men
4 Hematuria - Epidemiology SpecificGlomerular causes -Predominate in children and young adults>40 y/o only 5% of casesNeoplasm>40 y/o, Urinary tract 15-20% of casesChildren: Wilm’s tumor, Rhabdomyosarcoma of bladder
7 Hematuria - Evaluation UrinalysisProteinuria - indicator of glomerular diseasecan be up to 500 mg/24 hr in gross hematuriaRBC cast - must look at urine with your own eyesPyuria - look for UTI/STDCrystalsDysmorphic RBC’s
19 Hematuria - CasesCase 344 y/o male gross hematuria and episodic flank pain radiating to groin on left side. Unable to find comfortable position.PE - uncomfortable, distressed, restlessUA - gross hematuria
20 Hematuria - CasesCase 475 y/o male with microscopic hematuria on screening. Hx of hesitancy and weakened urinary stream.PE - 150/85, enlarged prostate without nodularity/tendernessUA RBC’s/hpf
21 Hematuria - CasesCase 541 y/o male with 2 episodes of gross hematuria over last 24 hours.Completed AF marathon yesterdayPE - unremarkableUA RBC’s/hpf
22 Hematuria - CasesCase 652 y/o female with 4 day hx of upper respiratory sx of cough, fever, scant sputum production.Over 24h, progresses to Acute respiratory failurePE - on vent, febrile, normotensive, oliguric, bloody sputum, anemic.UA - microscopic hematuria, + Legionella antigen, occ dysmorphic RBC’s, BUN/Cr = 54/ CXR - B/L patchy infiltrates
23 Hematuria - CasesCase 739 y/o male construction worker presents to ED with L arm swelling and tenderness. Denies trauma. + warmth/erythema x4dTeated with Keflex x 7d.10 d post ATBX, notices blood in urinePE - L arm nl, 150/85, NADUA RBC/hpf, occ dysmorphic rbc, no casts, bac, WBC reported.
24 Hematuria - CasesCase 820 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.