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{{Hematuria}}
{{Hematuria}}
{{CMG}}; {{AE}} {{Adnan Ezici}} {{VSKP}}
=Overview=
Patients with hematuria usually appear normal. Physical examination findings of patients with hematuria usually depends on the underlying etiology.


Physical examination of the patient with hematuria should focus on the [[genitourinary system]] (e.g., flank tenderness; masses in the flank, abdomen, suprapubic area, or [[urethra]]; and enlarged, nodular, tender, or fluctuant [[prostate]]). Physical examination also may identify signs of [[coagulopathy]] (bruising), infection (fever), or [[renal disease]] ([[hypertension]], [[edema]]). If [[urethral stricture]] or [[benign prostatic hyperplasia]] ([[BPH]]) is suspected, a urine flow rate and postvoid residual measurement may be helpful as well.<ref name="Campell">{{cite book | last = Wein | first = Alan | title = Campbell-Walsh urology | publisher = Elsevier | location = Philadelphia, PA | year = 2016 | isbn = 978-1455775675 }}</ref>
== Physical Examination ==
Physical examination of the patient with [[hematuria]] should be focused on finding the underlying cause. The physical examination findings vary depending on the [[etiology]].  


===Appearance of the Patient===
*Patients with hematuria usually appear normal.
=== Vital Signs ===
* [[Blood pressure]], [[heart rate]], [[respiration rate]], temperature, and consciousness level are important to assess [[hemodynamic]] stability, volume status, and possible presence of [[shock]] or [[sepsis]] as the treatment of hematuria is driven by the underlying [[pathophysiology]] and is in large part conservative.<ref name="pmid34233098">{{cite journal |vauthors=Ingelfinger JR |title=Hematuria in Adults |journal=N Engl J Med |volume=385 |issue=2 |pages=153–163 |date=July 2021 |pmid=34233098 |doi=10.1056/NEJMra1604481 |url=}}</ref>
=== Skin ===
* Skin and mucosal membrane examination are useful to check for signs of bleeding disorders, such as [[petechiae]], [[purpura]], [[ecchymoses]], and [[gingival bleeding]].
===HEENT===
* HEENT examination of patients with hematuria is usually normal. However, there might be some physical examination findings depending on the etiology.
** Bilateral [[sensorineural hearing loss]] might be seen in patients with [[Alport syndrome]].<ref name="pmid29262041">{{cite journal |vauthors=Watson S, Padala SA, Bush JS |title= |journal= |volume= |issue= |pages= |date= |pmid=29262041 |doi= |url=}}</ref>
** Eye problems such as anterior [[lenticonus]] or [[cataracts]] might also be seen in patients with Alport syndrome.
* Periorbital edema might be seen in patients with [[nephritic syndrome]].<ref name="pmid30855843">{{cite journal |vauthors=Rawla P, Padala SA, Ludhwani D |title= |journal= |volume= |issue= |pages= |date= |pmid=30855843 |doi= |url=}}</ref>
=== Neck ===
* Neck examination of patients with hematuria is usually normal. However, [[jugular venous distention]] indicates volume overload.
===Lungs===
* [[Pulmonary]] examination of patients with hematuria is usually normal.
===Heart===
* [[Cardiovascular]] examination of patients with hematuria is usually normal.
===Abdomen===
* Abdominal examination of patients with hematuria is usually normal. However, there might be some physical examination findings depending on the etiology.<ref name="pmid34233098">{{cite journal |vauthors=Ingelfinger JR |title=Hematuria in Adults |journal=N Engl J Med |volume=385 |issue=2 |pages=153–163 |date=July 2021 |pmid=34233098 |doi=10.1056/NEJMra1604481 |url=}}</ref>
** Suprapubic tenderness might indicate [[kidney stones]] or [[urinary tract infection]] (UTI).
** A palpable abdominal mass 
===Back===
* Costovertebral angle tenderness might be a finding on physical examination, which might indicate urinary tract infection or kidney stones.<ref name="pmid34233098">{{cite journal |vauthors=Ingelfinger JR |title=Hematuria in Adults |journal=N Engl J Med |volume=385 |issue=2 |pages=153–163 |date=July 2021 |pmid=34233098 |doi=10.1056/NEJMra1604481 |url=}}</ref>
===Genitourinary system===
* Enlarged, nodular, tender, or fluctuant [[prostate]]. Prostate palpation is important for evaluation of [[prostatitis]] and [[prostate cancer]] in male patients with hematuria.<ref name="pmid34233098">{{cite journal |vauthors=Ingelfinger JR |title=Hematuria in Adults |journal=N Engl J Med |volume=385 |issue=2 |pages=153–163 |date=July 2021 |pmid=34233098 |doi=10.1056/NEJMra1604481 |url=}}</ref>
** Urine flow rate and postvoid residual measurement may be helpful in further workup as well.<ref name="Campell">{{cite book | last = Wein | first = Alan | title = Campbell-Walsh urology | publisher = Elsevier | location = Philadelphia, PA | year = 2016 | isbn = 978-1455775675 }}</ref>
* Identification of the location of bleeding (being sure that it is not originating from the reproductive tract) is important in female patients with hematuria.
===Neuromuscular===
* Neuromuscular examination of patients with hematuria is usually normal.
===Extremities===
* Extremities examination of patients with hematuria is usually normal. However, pitting [[edema]] of the extremities might be seen in some diseases with [[glomerulonephritis]] such as [[poststreptococcal glomerulonephritis]] (PSGN).<ref name="pmid30855843">{{cite journal |vauthors=Rawla P, Padala SA, Ludhwani D |title= |journal= |volume= |issue= |pages= |date= |pmid=30855843 |doi= |url=}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Nephrology]]
[[Category:Nephrology]]
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[[Category:Urologic Disease]]
[[Category:Urologic Disease]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Needs content]]
[[Category:Primary care]]
{{WH}}
{{WS}}

Latest revision as of 03:31, 4 August 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2] Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]

Overview

Patients with hematuria usually appear normal. Physical examination findings of patients with hematuria usually depends on the underlying etiology.

Physical Examination

Physical examination of the patient with hematuria should be focused on finding the underlying cause. The physical examination findings vary depending on the etiology.

Appearance of the Patient

  • Patients with hematuria usually appear normal.

Vital Signs

Skin

HEENT

Neck

Lungs

  • Pulmonary examination of patients with hematuria is usually normal.

Heart

  • Cardiovascular examination of patients with hematuria is usually normal.

Abdomen

  • Abdominal examination of patients with hematuria is usually normal. However, there might be some physical examination findings depending on the etiology.[1]

Back

  • Costovertebral angle tenderness might be a finding on physical examination, which might indicate urinary tract infection or kidney stones.[1]

Genitourinary system

  • Enlarged, nodular, tender, or fluctuant prostate. Prostate palpation is important for evaluation of prostatitis and prostate cancer in male patients with hematuria.[1]
    • Urine flow rate and postvoid residual measurement may be helpful in further workup as well.[4]
  • Identification of the location of bleeding (being sure that it is not originating from the reproductive tract) is important in female patients with hematuria.

Neuromuscular

  • Neuromuscular examination of patients with hematuria is usually normal.

Extremities

References

  1. ↑ 1.0 1.1 1.2 1.3 Ingelfinger JR (July 2021). "Hematuria in Adults". N Engl J Med. 385 (2): 153–163. doi:10.1056/NEJMra1604481. PMID 34233098 Check |pmid= value (help).
  2. ↑ Watson S, Padala SA, Bush JS. PMID 29262041. Missing or empty |title= (help)
  3. ↑ 3.0 3.1 Rawla P, Padala SA, Ludhwani D. PMID 30855843. Missing or empty |title= (help)
  4. ↑ Wein, Alan (2016). Campbell-Walsh urology. Philadelphia, PA: Elsevier. ISBN 978-1455775675.

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