1. HEMATURIA Danger Signal that can’t be ignored

3. 1. Duration of symptoms and are they painful? 2.Presence of symptoms of an irritated bladder 3.What portion of the urinary stream has blood present?

5. 1. microscopic hematuria- >3RBC’s/HPF X3 - 100RBC’s/HPF 2.proteinuria>500mg/24hrs or RBC casts -blood cultures, complement levels, HIV, hepatitis, renal biopsy -causes- IGA nephropathy(Berger’s Disease), hereditary nephritis, thin basement membrane disease 3. evaluation- needs to be referred to nephrology

6. Red Urine- beets -red coloring in food -phenolphthalein -porphyria -hemoglobin, myoglobin

7. No proteinuria or RBC casts Evaluation-pyuria, WBC casts-need urine culture -urine cytology -UA of family members -24 hr urine for calcium and uric acid

9. Imaging- CAT with and without contrast -ultrasound Endoscopy-cystoscopy with biopsies, possible retrogrades Follow periodic urinalysis

10. -single UA with hematuria is common and can result from menstruation,viral illness, allergy, exercise or mild trauma -in pediatrics, neoplasms are rare, idiopathic or congenital problems are common

11. Gross Hematuria- almost never glomerular bleeding, urologic in nature - patients chronically anticoagulated should be evaluated, evaluation is similar to microscopic hematuria, imaging and cystoscopy

12. Urinary Stones Hematuria with colic suggests a stone Calcium stones- most common,80%, familial Uric acid stones-radiolucent, more common in men Cystine stones-uncommon, diagnosed in pediatric ages Struvite stones-common, related to infections, oftenProteus

18. Elevated 24 hr urine for calcium or uric acid Evaluation-CAT without contrast, IVP not indicated Treatment-ESWL, ureteroscopy, percutaneous surgery, medical treatment may be low sodium, low protein diet, do not restrict calcium, use of thiazides

19. URINARY TRACT INFECTIONS Ecoli-80% of infections, others Proteus, Klebsiella, Pseudomonas, catheter patients should not be treated if asymptomatic UA, Urine Culture needed After each course of treatment, a UA is needed to determine if the treatment was effective or the problem due to something else Macrodantin, Septra, try to avoid fluroquinolones

23. NEOPLASMS Bladder Cancer- common related to cigarette smoking, usually transitional cell, presentation is usually painless hematuria Treatment- resection of tumor, use of mitomycin, use of BCG, more aggressive tumors treated with chemo, radiation, or cystectomy

29. Renal Cell carcinoma The incidence of this tumor is rising, familial factors, hematuria, flank pain, abdominal mass Treatment- nephrectomy, partial nephrectomy is now used more often,survival is actually better -tumors often are radiation resistant - some new chemotherapy helps

30. BPH AND PROSTATE CANCER Bleeding may occur spontaneously from either, without prior manipulation Treatment- often resection is needed to stop the bleeding

31. TRAUMA Renal Trauma- usually treated without surgery Bladder Trauma- open surgery is needed if rupture is in the peritoneal cavity Urethral Injury- Local x-ray evaluation is needed to determine the site of injury

36. TB AND SCHISTOSOMIASIS Not common in this area, but in some parts of the world a major cause

37. Approach should be compulsive in diagnosis History and exam are very important, presence of pain, blood pressure evaluation, hx of physical activity, food intake Make sure the blood is gone after the treatment that is given