Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
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2. DEFINITION
More than three red blood cells are found in
centrifuged urine per high-power field
microscopy ( > 3 RBC/HP).
Normal urine:
no red blood cell or less than 3 red blood cell
3. Classification
According to the amount of RBC in the
urine, hematuria can be classified as:
• gross hematuria (visible) • microscopic hematuria
tea-colored, cola-colored, pink or normal colour with eyes
even red
4. Classification
Another classification by Timing (when it occurs
during urination), which may indicate the location of
the problem.
Initial hematuria: Onset of urination – urethra.
Total hematuria: Throughout urination – bladder,
ureter, or kidneys.
Terminal hematuria: End of urination – bladder or
prostate (men).
5. ETIOLOGY
Diseases of the urinary system— the most
common cause
a- Glomerular
b- Interstitial
c- Uroepithelium
d- Vascular
8. System disorders (less common)
a. Hematological disorders
aplastic anemia - leukemia - hemophilia -
ITP (idiopathy thrombocytopenic purpura)
b. Infection
infective endocarditis - septicemia - epidemic
hemorrhagic fever - scarlet fever - filariasis
c. Connective tissue diseases
SLE - polyarteritis nodosa
d. Cariovascular diseases
hypertensive nephropathy- chronic heart failure -
renal artery sclerosis
e. Endocrine and metabolism diseases
gout - diabetes mellitus
9. Diseases of adjacent organs to urinary
tract
appendicitis
carcinoma of the rectum
carcinoma of the colon
uterocervical cancer
Drug and chemical agents
anticogulation cyclophosphamide
miscellaneous
exercise induced hematuria
10. DIFFERENTIAL DIAGNOSIS
• Polluted urine: menstruation
• Drug and food: Rifampicin, Nitrofurantoin,
sulfonamides, adriamycin.
• Porphyria: porphyrin in urine (+)
• Hemoglobinuria (hemolysis)
• Myoglobinuria
11. ACCOMPANIED SYMPTOMS
• Hematuria with renal colic
renal stone, ureteric stone.
• Hematuria with urinary frequency,urgency
and dysuria
bladder or lower urinary tract (TB or tumor)
If accompanied by high spiking fever, chill and loin
pain: pyelonephritis
12. ACCOMPANIED SYMPTOMS
• Hematuria with edema and hypertension
glomerulonephritis - hypertensive nephropathy
• Hematuria with mass in the kidney
neoplasm - hereditary polycystic kidney
• Hematuria with hemorrhage in skin and
mucosa
hematological disorders - infectious diseases
• Hematuria with chyluria filariasis
16. LABORATORY TESTS
Three-glass test
Method: collecting the three stages of urine of
a patient during micturition
Result:
the initial specimen containing RBC—the urethra.
the last specimen containing RBC—the bladder.
neck and trianglar area, post. Urethra.
all the specimens containing RBC—upper urinary
tract, bladder.
17. LABORATORY TESTS
Phase-contrast microscopy
to distinguish glomerular from post
glomerular bleeding
• Post glomerular bleeding:
normal size and shape of RBC
• Glomerular bleeding:
dysmorphic RBC (acanthocyte)