hematuria powerpoint urology lecture .pptx

Hematuria

1. Hematuria

2. Definition:- presence of red blood cells in the urine.

3. Classification of Hematuria

4. According to quantity:- Macroscopic hematuria Frank blood in urine resulting in visible red or brown discoloration of urine. suggests damage to kidneys, upper or lower urinary tract. Microscopic hematuria RBCs are present in urine sediment but no urine discoloration is visible by naked eye. It is defined as presence of >= 3RBCs per HPF It can indicate glomerular damage.

5. According to occurence during voiding:- Initial hematuria Terminal hematuria Total hematuria Occurs at begining of micturition and clears by end of micturtion. Passage of blood or clots in urine during the last part of micturition. Passage of blood or clots throughout the entire micturition. Typically suggests urethral damage. suggests damage to the bladder neck, prostste or trigonal area. Suggests damage to the bladder, ureter or kidneys.

6. According to origin:- Glomerular Hematuria Nephritic syndrome Isolated hematuria Transient Persistent Non glomerular hematuria Urolithiasis Malignancy Coagulation disorders Urinary tract obstruction Polycyctic kidney disease Renal papillary necrosis Trauma Drugs

7. Glomerular Hematuria Non glomerular Hematuria Brown or cola colored urine. Bright red, pinkn blood clots. usually associated with proteinuria. No proteinuria. RBCs casts No RBCs casts Dysmorphic RBCs Normal RBCs morphology

8. Is any red urine considered hematuria????

9. Other causes of red urine:- Non pathological Medications _ Rifampicin _Chloroquine _Nitrofurantoin _Metronidazole Food dies _Beets _Black berries Pathological Hemoglobinuria From hemolytic anemia Myoglobinuria From rhabdomyolysis

10. How do we evaluate hematuria? A- History of: Any possible cause e.g. trauma, operations and exposure to bilharziasis. Relation of hematuria to the act of micturition , It may be: - Initial (at the start of micturition ) due to a lesion at the posterior urethra or bladder neck. - Terminal (at the end of micturition) due to bladder lesion e.g. bilharziasis. - Total (the whole urine is red) due to bladder or upper urinary tract lesions. Presence of clots confirms true hematuria and may cause obstructive LUTS up to clot retention.

11. Associated pain helps in localization of the pathology e.g. _Renal pain with upper urinary tract lesions and painful micturition with bladder lesions. _Painless hematuria is present in e.g. BPH, transitional cell carcinoma (TCC) of urinary bladder, glomerulonephritis and bleeding tendencies.

12. B- Clinical examination: General examination: To detect any other bleeding sites and systemic effects of blood loss e.g. pallor, tachycardia and hypotension. Abdominal examination for renal swellings and clot retention. DRE for e.g. BPH and bladder tumor. Inspection of a voided urine sample.

13. Differential diagnosis: Total red discoloration of urine due to e.g. _some drugs (as rifampicin) _foods (as beet roots) The onset and offset are clearly related to the causative ingested material. The discolored urine is not turbid, with no clots or urologic manifestation. Bleeding per urethra which means blood trickling from the urethra without voiding due to a urethral lesion or trauma distal to the urinary sphincters. Contamination by menstrual bleeding , thus urine analysis is better avoided during menses.

14. Investigations: 1.Urine analysis: It confirms the diagnosis by detection of RBCs. The cause of hematuria may be detected e.g. bilharzial ova ,bacteria and crystals. It differentiates between glomerular hematuria(dysmorphic RBCs ,proteinuria and RBCs casts) and non-glomerular hematuria(eumorphic RBCs.) 2.Abdominal U/S(essential) can detect urologic lesions e.g. renal or bladder stones or tumors.

15. Further investigations according to the cause. When the cause of hematuria is not detected ,we resort to other specific investigations including checking the bleeding profile, urine cytology, cystoscopy, uretero-renoscopy and renal biopsy.

16. Treatment: Entails treatment of the cause besides: _Simple general measures :e.g. bed rest ,good hydration and hemostatic drugs. _With massive hematuria :hospitalization ,vital signs monitoring and blood transfusion. _Specific measures to stop massive bleeding e.g. hemostatic dose of radiotherapy in bladder cancer and angio-embolization in renal trauma or tumors.

17. According to the cause:-