1. Hematuria Resident Lecture

2. Hematuria
Diagnosis: presence of ≥ 3 RBCs on at least 2 separate urine samples
Gross: as little as 1cc can visibly change urine
Microscopic: detected by UA if there is at least 1-2 RBC/hpf
Because there are false positives urine microscopy is necessary to confirm presence of RBCs

5. Evaluation of hematuria
History taking is VERY important
Risk factors
Smoking history
Occupational exposure to chemicals or dyes (benzenes or aromatic amines)
History of gross hematuria
Age >40 years
History of urologic disorder or disease
History of irritative voiding symptoms
History of urinary tract infection
Analgesic abuse
History of pelvic irradiation
Systemic symptoms, exposures, exercise, infections, BPH, stones, dysuria, etc.

6. Evaluation of hematuria
Urine microscopy confirms RBCs present?
Gross v. microscopic hematuria?
Proteinuria present, how much?
Glomerular v. nonglomerular?
Glomerular: RBC casts, dysmorphic RBCs, proteinuria (typically > 1 gm), coca-cola color
Nonglomerular: nondysmorphic RBCs, clot formation (very rare in glomerular bleeding)
Indeterminate: presence of less than < 30 % dysmorphic RBCs, Proteinuria < 1gm, no RBC casts
Renal U/S results?

8. Etiology of Glomerular hematuria
Glomerulonephritis
Systemic disease (autoimmune)
Vasculitis – (WG, MPA, CS, HSP)
Lupus
TMA
Scleroderma
Hereditary/Other
Alport’s
TBM
Infection-associated GN
Nutcracker syndrome
Loin-pain hematuria

9. Evaluation of nonglomerular hematuria - LUT

10. Imaging studies for nonglomerular hematuria

11. Outcome
1% of older patients with an initially negative evaluation will, at three to four years, have a detectable urinary tract malignancy
In high risk patients, f/u cytology at 6, 12, 24, 36 months, consider repeat cystoscopy annually for persistent hematuria