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Hematuria - A Diagnostic Approach Douglas Stahura D.O. GVH 8/24/00.

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Presentation on theme: "Hematuria - A Diagnostic Approach Douglas Stahura D.O. GVH 8/24/00."— Presentation transcript:

1 Hematuria - A Diagnostic Approach Douglas Stahura D.O. GVH 8/24/00

2 Goals Epidemiology Evaluation Differential Diagnosis Case Reports

3 Hematuria - Epidemiology Definitions –Macroscopic - pink, red, or tea colored –Microscopic - >4 RBCs 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

4 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: Wilms tumor, Rhabdomyosarcoma of bladder

5 Hematuria - Evaluation History Physical Urinalysis

6 Hematuria - Evaluation

7 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 RBCs







14 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



17 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+

18 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

19 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

20 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 RBCs/hpf

21 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 RBCs/hpf

22 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 RBCs, BUN/Cr = 54/5.5 CXR - B/L patchy infiltrates

23 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 RBC/hpf, occ dysmorphic rbc, no casts, bac, WBC reported.

24 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.

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