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HAEMATURIA

Prepared and presented by : Iyad Al-haj Hamad Supervised by: Surgeon Omar Abd Alshafi

بسم الله الرحمن الرحيم

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Definition

Haematuria in UK English Hematuria in US English

Definition: is the passage of red blood cells in urine.

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Hematuria

Not all red urine is Hematuria>> may caused by› Haemoglobinuria› Myoglobinuria› Acute inttermittent porphyria ( error in metabolism of heam)

› Beetroot ( name of plant)

› Blackberries , food colors› Senna ( name of plant)

› Phenolphthalein Drugs :Rifampicin, Doxorubicin, Chloroquine, Deferoxamine,

Ibuprofen ,Iron sorbitol, Nitrofurantoin, Phenazopyridine ,Phenolphthalein

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Causes of hematuria

Kidney› Glomerular disease› Carcinoma › Stone› Trauma ( including renal biopsy)› Polycystic kidney› TB tuberculosis› Embolism › Renal vein thrombosis› Vascular malformation

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Causes of hematuria con. 1

Ureter› Stone› neoplasm

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Causes of hematuria con. 2

Bladder› Carcinoma › Inflammatory: e.g. cystitis, TB,

schistosomiasis› Stone› trauma

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Causes of hematuria con. 3

Prostate› Benign prostatic hypertrophy› carcinoma

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Causes of hematuria con. 4

Urethra› Trauma› Stone› Urethritis› neoplasm

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Causes of hematuria con. 5

General› Anticoagulant therapy› Thrombocytopenia› Strenuous exercise› Hemophilia› Sickle cell disease› Malaria

(common where malaria is endemic)

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History Pain associated with hematuria suggest

infection or inflammation. Painless hematuria suggests tumor or

tuberculosis. Total haematuria ( throughout the

stream ) suggest bleeding from the upper urinary tract or bladder.

Initial hematuria ( at the start of the stream) suggest bleeding from the urethra or the prostate

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History con. 1

Terminal haematuria (at the end of the stream) suggest bleeding from the bladder or the prostate.

Ask about family history of polycystic kidney disease

History of TB Any recent foreign travel suggest

schistosomiasis

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History con. 2

Loin pain suggest kidney disease History of ureteric colic suggest

passage of a stone or clot down the ureter

Suprapubic pain, frequency and dysuria suggest a problem in the bladder

Difficulty in starting poor stream and nocturia suggest prostatism ( lower urinary tract symptoms )

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History con. 3

History of falling astride , pelvic fracture or trauma suggest urethral injury

Is the patient on anticoagulant? Evidence of sickle cell disease or

exposure to malaria History of strenuous exercise Has there been any recent renal

biopsy?

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History con. 4

Others causing red urine not hematuria› Recent crush injuries or ischemia of the

muscles suggest myoglobiuria with haemolysis

› Eating or ingestion of substances that make urin red

› Acute inttermittent porphyria : rare disorder and accompanied by abdominal pain Urine if kept in light become purplish-red

االرجواني الى مائل احمر

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Examination

Look for anemia, weight loss and signs of chronic renal failure.

Abdominal examination for palpable mass egg polycystic kidney disease and distended bladder

Rectal examination to detect enlargement in prostate

Feel along the urethra for stones or neoplasm Examine the chest for TB and metastasis

from renal cancer.

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Investigations Full blood count and erythrocyte

sedimentation rate ( CBC & ESR)› Increase in WBCs so infection› ESR increase so malignancy or TB

Dipstick testing not enough you must do microscopy

Urine microscopy › Red blood cells ?› WBCs so infecton› Organisms so infection› Cytology for cancer cells

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Investigations con. 1

Urea and electrolytes for renal failure Clotting screen for anticoagulant Chest X-ray for metastasis Kidney Ureter Bladder plain X-ray for

calculus PSA for prostate cancer Sickling test for sickle cell disease Intravenous urography for stones and

tumor and TB.

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Investigations con. 2

Ultra sound for stone and urinary tract obstruction

Cystoscopy for infection tumor and stones Ureteroscopy for tumor and obstruction. Renal angiography for vascular

malformation and embolism Renal biopsy for renal tumor and

glomerular disease Prostatic biopsy for tumor of prostate

end

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Renal cell carcinoma

the most common in the primary malignant renal tumors

Occurs in old ages males : females 2:1 more common in

male derived from the renal tubular

epithelium ( adenocacinomas) 1% occur bilateral

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Renal cell carcinoma con.

Etiology: increased incidence in those who smoke tobacco , besides chemical carcinogens, von Hippel-lindau syndrome, and polycystic kidney

Symptoms› Pain› Haematuria› Weight loss› Flank mass› Hypertension

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Renal cell carcinoma con.

Diagnosis by:› IVP› Abdominal CT scan with contrast

Staging› Stage 1 : < 2.5 cm N0 M0› Stage 2 : > 2.5 cm limited to kidney N0 M0› Stage 3 : <2 cm with +ve lymph nodes

localy M0› Stage 4 : distanat M +ve, >2 cm , +ve N

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Renal cell carcinoma con.

main routes of metastasis is blood spread to› lung› Liver› Brain› Bone

Bad prognosis

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Renal cell carcinoma con.

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Bladder cancer

Second most common urologic malignancy

Transitional cell carcinoma ( most common) squamous or adenocarcinoma

Etiology : increase risk by smoking , carcinogens, schistosomiasis, truck drivers, petroleum workers , cyclophosphamide.

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Bladder cancer con.

Symptoms:› Painless Haematuria› Frequancy increase

Diagnosis:› Urinalysis and culture,› IVP› Cystoscopy› Cytology› biopsy

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Bladder cancer con.

Staging › Stage 0 : in situ› Stage 1 : invades sub epithelial tissue › Stage 2 : invades superficial or deep

musclaris propria› Stage 3 : invade perivesical tissue› Stage 4 : N +ve and distant M

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Bladder cancer con.

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Bladder cancer con.

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Prostate cancer

Most common genitourinary cancer Occur mostly in elderly about 70 Occur in males more than in

females ( for fun only) Type : most adenocarcinoma Symptoms:

› Asymptomatic› Found accidentally on PR

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Prostate cancer

Occur usually at peripheral parts of the gland

Etiology:› Not known

Diagnosis:› Trans rectal ultra sound › Trans rectal biopsy

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Benign prostatic hyperplasia

In elderly usually Occur at periurethrally Symptoms :

› Obstructive symptoms› Urinary retention› Hesitancy › Weak stream › Nocturia› intermittency › UTI

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Benign prostatic hyperplasia

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Benign prostatic hyperplasia

Diagnosed by› History› Digital rectal examination › Elevated post void residual???? › Urinalysis› Cystoscopy› Ultra sound

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Benign prostatic hyperplasia

Treatment› Alpha 1 blockers › Antiandrogen› Surgery› Trans urethral balloon dilatation

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Glomerular cause

1. Glomerular cause 1. Primary glomerulanephritis

1. IgA nephropathy2. Post streptococcal glomeruronephritis

2. Secondary glomerulonephritis1. Lupus nephritis2. Vaculitis3. Henoch Scolein purpura

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PSA

Prostate specific antigen : an enzyme produced by the glandular epithelium of the prostate . Increased in quantities are secreted when the gland is enlarged .

PSA increase in blood significantly in case of cancer above 4 ngram\ml

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Physical Examination con.

Examine the urethral opening and its place

Examine the scrotum and testis in male