haematuria

see also:

• urinary tract infections (UTIs) / cystitis
• urology
• renal medicine
• RCH guideline - haematuria

• coagulopathy
• sickle haemoglobinopathies

• primary glomerular disease
• multisystem disease:
  • SLE, HSP, HUS, PAN, Wegener's granulomatosis, Goodpasture's syndrome

• white cell casts (but these may be absent?):
  • TB
  • pyelonephritis
  • acute interstitial nephritis
  • papillary necrosis
  • polycystic kidney disease
• medullary sponge kidney
• renal infarction
• tumour
• vascular malformation
• trauma

• stones
• trauma
• tumour of ureter, bladder, urethra
• cystitis
• TB
• prostatitis, urethritis
• urinary catheter
• exercise
• benign prostatic hypertrophy

• GN, UTI, trauma

• UTI, stone, trauma, Ca bladder/kidney

• Ca bladder, stone, UTI, Ca kidney, BPH if > 60yrs

• UTI, stone, Ca bladder/kidney

• blood noted only on initiation suggests urethral cause
• blood seen mainly on last few drops suggests prostatic or bladder neck source (including blood clots pooling at base of bladder)
  • may occur after injury or straining
• haematuria throughout urination suggests source in bladder, ureter or kidney
• brown or smoky-colored urine usually has a renal source
• blood clots indicate non-glomerular renal or lower urinary tract source
• if cyclic with menses, may be due to endometriosis of ureter or bladder

• flank pain suggests calculus, neoplasm, renal infarction, obstruction or infection as a cause
• symptoms of dysuria, frequency or suprapubic pain suggests cystitis or urethritis
• in adult men, perineal pain, dysuria and terminal haematuria suggests prostatitis
• recent sore throat suggests possibility of post-streptococcal GN
• foreign travel or residence suggests schistosomiasis or TB
• drugs may cause acute interstitial nephritis, papillary necrosis, or haemorrhagic cystitis
• FH of HbS, polycystic or other kidney disease or renal calculi
• 15-20% of individuals exhibit haematuria after strenuous exercise which resolves in a few days

• arthritis, skin lesions, HT or oedema suggest GN
• new heart murmur (endocarditis) or AF suggests renal embolism
• costovertebral angle tenderness suggests pyelonephritis, stone disease
• enlarged kidney suggests polycystic kidney or malignancy
• prostatic examination may offer clues to presence of prostatitis, BPH or malignancy
• ext. genitalia may reveal urethral meatal lesion
• PV exam to exclude vulvovaginal causes of bleeding
• urinalysis with m/c/s if ? infective
• pathology tests - urea and creatinine
• if suspect calculi, polycystic kidney, tumour or obstruction then IVP or if C/I then US
• if active gross haematuria or no upper lesion then consider cystoscopy
• if elderly pt and other features are unhelpful then consider urinary cytology
• if asymptomatic, with no other abnormality on urinalysis, and not azotaemic, hypertensive, or severely anaemic, & who have no evidence of intrinsic renal disease, may be followed up as outpatients (?except if known bleeding disorder), others should generally be admitted for prompt evaluation.
• extensive OP evaluation is usually not undertaken for pts < 40 yrs with isolated episode of haematuria, but most patients over 40yrs should have a thorough evaluation

• 3 way catheter and bladder irrigation is usually required
• hydrogen peroxide may have a role - see J Int Med Res. 2020 A simple and effective method for bladder blood clot evacuation using hydrogen peroxide