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Hematuria by dr. Souparno mnadal

1. HEMATURIA SUBODH KUMAR SHAH Intern 9' batch

2. Definition: Hematuria is defined as the presence of 5 or mor red blood cells (RBCs) per high- power field in 3 of 3 consecutive centrifuged specimens obtained at teast 1 week apart.

3. classified as. Gross (ie,overtIy bloody, smoky, or tea-colored urine) Microscopic ^ 5 RBC"s /HPF (when it occurs during urination) Early (initial) haematuria: Urethral origin, distal to external Sphincter Terminal haematuria: Bladder neck or prostate origin ’ Di ffuse (total) haematuria Source is in the bladder or upper urinary tract can be

4. Glomeiular : Discolouration of urine from pigments such as colouring and myoglobin. is due to tumours of kidney or bladder unless prey, otherwise.

5. Diseases of the urinary system - the most common cause Glomerular Interstitial Uroepithelium Vascular

6. ' Gfomerutar ”• lgA nephropathy ° glomerulonephritis ¥' Interstitial Allergic interstitial nephritis Analgesic nephropathy + Renal cystic diseases * Acute pyelonephritis Tuberculosis Renal altograft rejection

7. Uroepithelium /\Malignancy Trauma Papillary Necrosis ’- Cystitis/Urethritis/Prostatitis Parasitic Diseases (Schistosomiasis) Stones Vascular •• Arterial emboli or thrombosis Arteriovenous fTstulae ^ Renal vein thrombosis

8. Hematotogical disorders- - aplastic anemia leukemia hemophilia\,ITP (idiopathic thrombocytopenic purpui Infection--infective endocarditis,Septicemia,epidemic hemorrh fever, scarlet fever,Filariasis Connective tissue diseases- - SLE ,polyarteritis nodosa Cardiovascular diseases-- hypertensive nephropathy, chronic heart failure - renal artery scferosise End ocr U ne and metabolism diseases-- gout - diab e

9. Diseases o :: u n n.a•y ad ec n: oceans ' Appendicitis carcinoma of the ectum cai cinoma of the colon uterocervical cancer C yc lophosphamide, rif ampin, sulfonamide, phenytoin, exercise induced hematuria

10. Renal sIone Tr›nercraosis Trauma ” Ttzherctaiosts Bladder s‹one Endemic fi+aematuria Ure‹eric tumour Bladder iumo‹ r• C arcinoma proslalo

11. DIFFERENTIAL DIAGNOSIS Polluted urine: menstruation Drug and food: Rifampicin, Nitrofurantoin, sulfonamides, riamycT Porphyrta: porphyrin in urine (+) Hemaglobinuria (hemolysis) Myoglobinuria

12. i ns and symptoms 7he: firststep in the eve/uaf/on of hemafurio consisfs of o detaileó anó..o fho .agh. Efforts sf›auId be mode to d‹stinguish g/omeru/or causes from extraglcmerulor one.' LPoss oge.of c/ots in cine suggesrs on exfrog/omeru/ar couse '•Rs'"enf trauma to the abdomen may óe in.dicotive of hydranepñro*s. '• r/y- mornir›g periorbitol puffiness. weighl goin, oIigurI.o. dot- co/oreó. /4 malaria crue lo g/omeru/or causes is pain/ess eecenf throot ór skin infecfion ma.y suggesf posfinfectiDÜs omei /onephri/is

13. Sifiin ro shes and.orthritis con occur in /4enoch- Scf›’ânlein p”urpuro and systemic Lupus eryfhemotosus /nformotion regording exercise, menstruation, recent 6lodder cafheterizofion, intake of certain arugs or toxic suDsfonces, . c› t passage of a calculus mo.y also assist in the ctifferenf/o/ diagnosis. A family history that is suggestive of A/port syndrome. collagen vascular cfiseases. uro/ithiasis. or polycystic kidney disease is ’an

14. î"'hysica/ examinotion M. eosL/rement of the b/oocf pressure and volume stötus is.especia//y important when glomeru/önephrifis is ô considerafion. ¥ Évaluation for the presence of periorbita/ puffiness or peripheral ëdërn skin exominaf/on to moi for porpuro. Abcfornînö/ exominafion ta look for pa/pob/e mass reveô/s o rer› al.turnôr or hydronephrosis.moy exist. A pa/pcthe bladder after voiding indicates oDsfruction or ré..I entian

15. /wöys cheek for extrorenol manifestafions and co mórb/d ’.üö ditiÓns. fi• Af›eck for ofher safes of bleeding. P9 exominoliön shou/d nor öe misseö. ro diognose pros›of‹f‹s, prostote cancer, ep dic/ymi/is,. meofof sfenosis, and ofher structvra/ couses o/ hemoturia . •.’ In”spec,t external genitalia in male for trauma. ¥• .A io/ fibrill ation raises the possibility of Meno/ embo/ic inforction, specially if the patient has flank pain Üostoverteöral angle tenderness is also suggestive of gye'/onëphritis, nëphrolithiasis, or vreterooe/vic jun'ction obsfrü,ctiön\ O,etöi/eõ.’o hthõ/mo/ogic evø/uotiÒrj {in familial herriöforiõ}

16. the:ioborofo‹y fesfs ordered /or tne evoNotion of i büsed’on fhe clínícol histo/y anü the physica/ examina on. Tests” th”ot may óe he/pfu/ include the following: L/riao/ysis wifh carefo/ m/croscopic review of he urine sarnp/e Urlnd dip strip analysts it is the most commonly used methocf.of tsting the u e for b/oocf is the urine test strip or lipstick, which •utilizes.the pe' idose- like ocfivify of Inemoglobin to generate d dolor ohorige. .a/se- positive fesfs may oc •cur in the selling of myoglaloinuria r fiém.op/obinurid: con firmed by tlne bsenc of R8Cs n •zii - r ' ” .. •'”. .exominotion. a a . r . - - ,

17. Phose- contrast mle roscopy to help determine the source.of.tf›e. ólèedirig Hem. a tolagic ond coagulation studies (eg, complète b/öbd. c›ùrit [CBC} ond, sometimes. p/ofe/e/ counts) Baod.urea nitrogen tBUH/ for poroneop/ostic.síndrome and serum creotinine /eve/s for kidney foilure. ógic testing (eg. oomp/ement. onfisfrepto/ysin CASOS. onfi- ’ose B. ontinúc/ear anfibocly /ANAJ. and doub/e-stronded DHA I/rine culture tor suspec fed 'riri.ary !tract infec/ion U7/J

18. lüsa.gïng studies rhe föllöwin‹g may Lee he/ofu/: !!neno/.ond ö/odder u/frosonography !ICT urbgrophy: now rep/oces /vL/. ï.Pefrog. e pyeIogroph.y. 'ëë öl iöpsy: in nephro/ogico/ cases s

19. Kidney biO@5 is rarely inc/icofed: 'Significant proteinurio ’RecucenTpecisenfhemoTuno .Serologic aDnormo/ifies toDnormo/ complement, ANA, or dsDNA /eve/sJ u rent gross hemoturia lily history ot end- stage renal disease

20. lomerular hemafuria: own- colored urine. RBC casfs. and .omefimes frogmentedJ RBCs and profeinorio or pink urine, passage of blood clots, ono phic /normo/- sized. Diconcgve/y shoped/

21. «o'gemenf: Hernaforfo is a sign old not itself a disease: thus. therapy should be directed of the process causing Asymptomatic (iso/afec/J hemafuria generally does not réquirje’ tre'afment. concfitions ossociofed with aL›' normal c/inico/, ofory or imaging studies, treatment may be r›ecessory. as .oppropriate. with the prim.ory diagnosis

22. urQicö/ infervenfion may öe necessory with certain anatomie briarmo/itiës (eçt. ureterope/vic i nction oös/ruotiori. tùrnor. ör 'siç/nificanf uroIithiasi'sj Eiiefory modification is usually nof indicated, except for cii/cfren who. m.ay tend to develop hypertension or edema as a result of the dii use process /e . nephrifis/ Po*••.'* s with peisisten! microscopic hemoforia should be monitorecJ 6-/2 months for fhe appearance of signs o ‹ ^Y D! • of progressive rena/ disease

23. ORTALITY/MORBIDITY IN GENERAL, CHILDREN WITH ISOLATED ASYMPTOMATIC MICROSCOPIC HEMATURIA TEND TO DO WELL, WHEREAS THOSE WITH ASSOCIATED FINDINGS (EG, HYPERTENSION, PROTEINURIA, ABNORMAL SERUM CREATININE LEVELS) ARE MORE LIKELY TO HAVE SERIOUS PROBLEMS. BECAUSE HEMATURIA IS THE END RESULT OF V PROCESSES, THE MORBIDITY AND MORTALITY THE CONDITION DEPEND ON THE PRIMA INITIATE D IT ” Uh... when you key HICROScopIc that maan It Is }us£

24. INCIDENCE OF HEMATURIA IN SPECIFIC RACIAL GROUPS IS DETERMINED BY THE PRIMARY CAUSE, FOR EXAMPLE, IDIOPATHIC HYPERCALCIURIA IS INFREQUENT IN BLACK AND ASIAN CHILDREN, BUT RELATIVELY COMMON IN WHITES. CONVERSELY, HEMATURIA CAUSED BY SICKLE CELL DISEASE IS MORE C M IN BLACKS THAN IN WHITES.

25. SEX: MAY PREDISPOSE A CHILD TO SPECIFIC DISEASES THAT MANIFEST AS HEMATURIA. FOR EXAMPLE, THE SEX- LINKED FORM OF ALPORT SYNDROME HAS A MALE PREPONDERANCE, WHEREAS LUPUS NEPHRITIS IS MORE COMMON IN ADOLESCENT GIRLS

26. AGE: NCE OF CERTAIN CONDITIONS VARIES 3R INSTANCE, WILMS TUMORS ARE MORE CHILDREN OF PRESCHOOL AGE, WHEREAS ACUTE POSTINFECTIOUS GLOMERULONEPHRITIS IS MORE FREQUENT IN THE SCHOOL- AGED POPULATION. IN ADULTS, HEMATURIA IS OFTEN A SIGN OF MALIGNANCY OF THE GENITOURINARY TRACT (EG, RENAL CELL CARCINOMA, BLADDER TUMORS, PROSTATIC TUMORS). THESE CONDITIONS ARE RARE IN CHILDREN.

27. THAN YOU