Hematuria resident survival guide: Difference between revisions

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!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| '''Initial hematuria:''' (Blood at beginning of micturition with subsequent clearing)}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| '''Terminal hematuria:''' (Blood seen at end of micturition after initial voiding of clear urine)}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| '''Total hematuria:''' (Blood visible throughout micturition)}}  
!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| '''Initial hematuria:''' (Blood at beginning of micturition with subsequent clearing)}} !!style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| '''Terminal hematuria:''' (Blood seen at end of micturition after initial voiding of clear urine)}} !! style="width: 300px;background:#4479BA"|{{fontcolor|#FFF| '''Total hematuria:''' (Blood visible throughout micturition)}}  
|-
|-
| ❑ '''[[STEMI resident survival guide#Treatment|STEMI / LBBB]]''' <br> ❑ '''[[NSTEMI resident survival guide#Treatment|NSTEMI / Unstable angina]]''' <br> ❑ '''[[Chronic stable angina treatment|Stable angina]]'''<br> ❑ '''[[Pericarditis resident survival guide#Treatment|Pericarditis]]'''<br> ❑ '''[[Aortic dissection resident survival guide#Treatment|Aortic dissection]]'''<br> ❑ '''[[Aortic stenosis resident survival guide#Treatment|Aortic stenosis]]'''  <br>❑ '''[[Prinzmetal's angina#Medical Therapy|Prinzmetal's angina]]''' <br> ❑  '''[[PCI complications: coronary vasospasm#Treatment|PCI-induced coronary vasospasm]]''' <br> ❑ '''[[New guidelines for the management of cocaine chest pain|Cocaine induced coronary vasospasm]]'''
| ❑ '''[[Urethritis]]''' <br> ❑ '''[[NSTEMI resident survival guide#Treatment|NSTEMI / Unstable angina]]''' <br> ❑ '''[[Chronic stable angina treatment|Stable angina]]'''<br> ❑ '''[[Pericarditis resident survival guide#Treatment|Pericarditis]]'''<br> ❑ '''[[Aortic dissection resident survival guide#Treatment|Aortic dissection]]'''<br> ❑ '''[[Aortic stenosis resident survival guide#Treatment|Aortic stenosis]]'''  <br>❑ '''[[Prinzmetal's angina#Medical Therapy|Prinzmetal's angina]]''' <br> ❑  '''[[PCI complications: coronary vasospasm#Treatment|PCI-induced coronary vasospasm]]''' <br> ❑ '''[[New guidelines for the management of cocaine chest pain|Cocaine induced coronary vasospasm]]'''
| ❑ '''[[Pulmonary embolism resident survival guide#Treatment|Pulmonary embolism]]'''<br> ❑ '''[[Tension pneumothorax resident survival guide#Treatment|Pneumothorax]]'''<br>❑ '''[[Asthma exacerbation resident survival guide|Asthma exacerbation ]]'''<br> ❑ '''[[Pulmonary hypertension resident survival guide#Treatment|Pulmonary hypertension]]'''<br> ❑ '''[[Pneumonia medical therapy |Pneumonia ]]''' <br> ❑ '''[[Pleurisy medical therapy |Pleuritis]]'''
| ❑ '''[[Pulmonary embolism resident survival guide#Treatment|Pulmonary embolism]]'''<br> ❑ '''[[Tension pneumothorax resident survival guide#Treatment|Pneumothorax]]'''<br>❑ '''[[Asthma exacerbation resident survival guide|Asthma exacerbation ]]'''<br> ❑ '''[[Pulmonary hypertension resident survival guide#Treatment|Pulmonary hypertension]]'''<br> ❑ '''[[Pneumonia medical therapy |Pneumonia ]]''' <br> ❑ '''[[Pleurisy medical therapy |Pleuritis]]'''
| ❑ '''[[Pancreatitis medical therapy |Pancreatitis ]]''' <br> ❑ '''[[Acute cholecystitis resident survival guide#Treatment Approach|Acute cholecystitis]]''' <br> ❑ '''[[Gastroesophageal reflux disease medical therapy|GERD]]''' <br>❑ '''[[Peptic ulcer medical therapy|Peptic ulcer]]''' <br>❑ '''[[Nutcracker esophagus medical therapy|Esophageal spasm]]'''<br>❑ '''[[Mallory-Weiss syndrome medical therapy|Mallory-Weiss syndrome]]''' <br>
| ❑ '''[[Pancreatitis medical therapy |Pancreatitis ]]''' <br> ❑ '''[[Acute cholecystitis resident survival guide#Treatment Approach|Acute cholecystitis]]''' <br> ❑ '''[[Gastroesophageal reflux disease medical therapy|GERD]]''' <br>❑ '''[[Peptic ulcer medical therapy|Peptic ulcer]]''' <br>❑ '''[[Nutcracker esophagus medical therapy|Esophageal spasm]]'''<br>❑ '''[[Mallory-Weiss syndrome medical therapy|Mallory-Weiss syndrome]]''' <br>

Revision as of 15:43, 12 August 2020

Hematuria
Resident Survival Guide
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Overview

Presence of >5 red blood cells (RBCs) per high-power microscopic field in the urine is called hematuria. It can have either benign or malignant etiology. Patients with hematuria could be asymptomatic. Therefore, all patients presenting with a single episode of haematuria require urgent investigation. Microscopic hematuria, or microhematuria (MH), is defined as the presence of RBC on microscopic examination of the urine not evident on visual inspection of the urine. The prevalence of MH among healthy participants in screening studies is 6.5% (95% confidence interval [CI] 3.4 to 12.2), with higher rates in studies with a predominance of males, older patients, and smokers.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Children[1] Age <50 years[2] Age >50 years[2]

Diagnosis

The approach to diagnosis of hematuria is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of hematuria.

 
 
 
 
 
 
 
 
 
 
 
 
Seek proper history:
❑ Onset
❑ Progression
❑ Pain/burning on urination
❑ Fever
❑ Abdominal pain/flank pain
❑ Polyuria, frequency
❑ Straining during urination
❑ Nocturia
❑ Weak stream
❑ Dribbling
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:
❑ Tachypnea
❑ Cold and clammy skin
❑ Hypotension
❑ HEENT signs:


❑ Cardiovascular exam:


❑ Abdominal exam:

  • Costovertebral angle (CVA) tenderness

❑ skin exam:

  • Look for rash

❑ Musculoskeletal exam:

  • Joint pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initial workup for hematuria:
❑ Complete blood count (CBC) with differential
❑ Urinalysis, urine strain, and culture
❑ Blood urea nitrogen:creatinine (BUN:Cr)
❑ Ultrasound (U/S) and CT abdomen
❑ Cystoscopy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine dipstick positive for heme:
  • Does microscopic urinalysis reveal >3 RBC/HPF?
    ❑ Yes
    (Consider hematuria)
    ❑ No
    (Causes include free urinary hemoglobin (from intravascular hemolysis), or free urinary myoglobin (from rhabdomyolysis). In men, the presence of semen in the urine sample may produce a positive dipstick from heme.)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initial hematuria: (Blood at beginning of micturition with subsequent clearing)
  • Consider differential diagnosis:
    ❑ Urethritis
    ❑ Trauma (e.g, catheterization)
 
Terminal hematuria: (Blood seen at end of micturition after initial voiding of clear urine)
  • Consider differential diagnosis:
    ❑ Urothelial cancer
    ❑ Cystitis (Infectious/post radiation)
    ❑ Urotheliasis
    ❑ Benign prostatic hypertrophy
    ❑ Prostate cancer
    •  
    Total hematuria: (Blood visible throughout micturition)
  • Consider differential diagnosis:
    ❑ Renal mass (benign/malignant)
    ❑ Glomerulonephritis
    ❑ Urolithiasis
    ❑ Polycystic kidney disease
    ❑ Pyelonephritis
    ❑ Urothelial cancer
    ❑ Trauma
    •  
     

    Treatment

    The management of hematuria will depend on the underlying cause. Click on each disease shown below to see detail management for every cause of hematuria.

    Initial hematuria: (Blood at beginning of micturition with subsequent clearing) Terminal hematuria: (Blood seen at end of micturition after initial voiding of clear urine) Total hematuria: (Blood visible throughout micturition)
    ❑ Urethritis
    ❑ NSTEMI / Unstable angina
    ❑ Stable angina
    ❑ Pericarditis
    ❑ Aortic dissection
    ❑ Aortic stenosis
    ❑ Prinzmetal's angina
    ❑ PCI-induced coronary vasospasm
    ❑ Cocaine induced coronary vasospasm     		❑ Pulmonary embolism
    ❑ Pneumothorax
    ❑ Asthma exacerbation
    ❑ Pulmonary hypertension
    ❑ Pneumonia
    ❑ Pleuritis     		❑ Pancreatitis
    ❑ Acute cholecystitis
    ❑ GERD
    ❑ Peptic ulcer
    ❑ Esophageal spasm
    ❑ Mallory-Weiss syndrome
    		❑ Musculoskeletal pain:
    ❑ Costochondritis
    ❑ Rheumatoid arthritis
    ❑ Rib fracture

    ❑ Herpes zoster
    ❑ Anxiety
    ❑ Panic disorder

    Do's

    • The content in this section is in bullet points.

    Don'ts

    • The content in this section is in bullet points.

    References

    1. ↑ Amin, Nimisha; Zaritsky, Joshua J. (2011). "Hematuria": 258–261. doi:10.1016/B978-0-323-05405-8.00069-3.
    2. ↑ 2.0 2.1 "www.surgeryjournal.co.uk".


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