Hematuria class
Post on 03-Jul-2015
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HEMATURIA
Waleed Dawood
Lecturer , Urology
Alexandria University
Hematuria
• Definition
• Classification
• Etiology
• Diagnosis
• Differential diagnosis
• treatment
Hematuria
• Definition:
Presence of greater than 3 RBC / HPF on properly collected urine specimen
Hematuria
• Classification:
1- Microscopic or gross hematuria
2- Urologic or nephrologic hematuria Urologic from peripheral calyces to external meatus
Nephrologic is glomerular in origin
Hematuria
Etiology: 1- Urologic hematuria:
a- neoplasm
b- BPH
c- stones
d- infections
e- trauma
f- iatrogenic
g- vascular causes
Anterior Nutcracker Syndrome
AOAO
SMASMA
Hematuria
Etiology: 2- Nephrologic hematuria:
a- post-streptococcal GN. b- SLE c- hemolytic uremic syndrome d- subacute bacterial endocarditis e- periarteritis nodosa
Hematuria
Etiology: 3- Hematologic hematuria:
a- hemophilia
b- von willebrand disease
c- ITP
d- Sickle cell trait
e- DIC
4- Exercise hematuria:
long-distancce runners
Hematuria
• Diagnosis:
1- History
2- Examination
3- Investigations
Hematuria
Diagnosis: 1- HISTORY:
a- Age: pediatric age most common cause…..
most common urologic cause…
adolescents adults old age b- sex : menstruation
Hematuria
Diagnosis: 1- HISTORY:
c- Analysis of hematuria: intensity of hematuria shape of blood clots associated symptoms timing of hematuria color of hematuria
Hematuria
Diagnosis: 1- HISTORY:
d- history suggestive of the cause: heavy exercise external trauma recent surgery drugs history of hematologic dis. history of nephrologic dis.
Hematuria
Diagnosis: 2- EXAMINATION:
a- General: vital parameters edema lower limbs purpuric rash b- Abdominal: renal mass full bladder cirrhotic liver
Hematuria
Diagnosis: 2- EXAMINATION:
c- Rectal (Vaginal): bladder mass BPH prostate Ca d- Genital: urethral prolapse urethral discharge
Hematuria
Diagnosis: 3- INVESTIGATION:
a- Laboratory: urine: urine analysis fresh,mid-stream,no menstruation Normomorphic or Dysmorphic
urine culture urine cytology Ziel Neelsen
Hematuria
Diagnosis: 3- INVESTIGATION:
a- Laboratory: blood: CBC Hematologic tests bleeding & clotting time
Nephrologic tests ASO titre Complement
Hematuria
Diagnosis: 3- INVESTIGATION:
b- Imaging: KUB Abdominal U/S IVU CT & MRI Angiography Ascending cystography Ascending urethrography
Hematuria
Diagnosis: 3- INVESTIGATION:
c- Endoscopy:
Cysto-urethroscopy
Ureteroscopy
d- Renal biopsy.
Hematuria
Differential Diagnosis: 1- Causes of red urine:
Hemoglobinuria Myoglobinuria Drugs e.g.
adriamycin,rifampicin,adriamycin….. Food e.g. beet roots
2- Causes of urethral bleeding.
Hematuria
Treatment:1- ttt of mild hematuria:
Hydration , Aminocaproic……..
2- ttt of severe hematuria: Intravenous line, blood transfusion Catheterization with evacuation of blood clots Continuous bladder irrigation Bladder & Prostate: Cystoscopic cauterization Alum, Silver nitrate, Phenol. Embolization of internal iliac artery Kidney : Embolization
3- ttt of the cause.
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