Hematuria class

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.