Haematuria

1
Haematuria
2

• Macroscopic
• Microscopic
• No consensus on what is normal 2-5 rbc/high
  powered field on microscopy
• Painful/Painless
• Pre-glomerular/Post-glomerular

3
Causes

• Gynaecological
• Kidney
• Ureter
• Bladder
• Prostate
• Urine discoloration (not haematuria)

4
Gynae causes

• Menstruation
• PMB
• Bleeding in pregnancy
• Cervical bleeding
• Atrophic vaginitis

5
Renal causes

• Stones
• Tumour
• Infection
• Glomerulonephritis
• Renal trauma/infarction

6
Ureter

• Stones
• Tumour (rare)

7
Bladder

• UTI
• Stones
• Tumour
• Chronic inflammation

8
Prostate

• Protatitis
• Tumour
• BPH

9
Other

• Rare Causes
• AV malformations
• TB
• Anticoagulation
• Vasculitides
• Infective endocarditis
• Polycystic disease
• Malignant Hypertension
• Anticoagulation

10
Other

• Beetroot ingestion
• Rifampicin
• Porphyria
• Urological symptoms
• ?frank haematuria
• Hx stones/urological problems
• Anticoagulation/Medication
• Occupation
• Smoking hx

11
History

• Urological symptoms
• ?frank haematuria
• Hx stones/urological problems
• Anticoagulation/Medication
• Occupation
• Smoking hx

12
Investigations

• MSU for MCS
• Bloods
• Renal function
• Hb
• If renal failure check ESR, Ca, LFT,
• If proteinuria and microscopic haematuria check
  24 hr urine protein excretion, serum
  electrophoresis, autoantibodies. Consider renal
  USS
• Clotting

13

• Imaging
• XR KUB
• IVU
• USS kidneys/ureters/bladder
• Further investigations
• Renal biopsy
• CT scan
• Cystoscopy

14
Urgent Referral

• Any pt with painless macroscopic haematuria
• gt40y recurrent or persistent UTI associated
  haematuria
• gt50y with unexplained microscopic haematuria
• Abdo mass identified clinically or on imaging
  thought to arise from urinary tract