Haematuria

Blood in the urine is abnormal. Generally, gross or macroscopic haematuria will be the reason you are called. Although haematuria is unlikely to result in significant blood loss, it may be associated with clot formation leading to urinary obstruction, be the first manifestation of a bleeding disorder or indicate the onset of urosepsis

Urinalysis:

• Blood (Detect haemolysed and non-haemolysed blood)
  • Haemolysed associated with low osmolality, low pH and prolonged sample time associated with RCC lysis
  • False +ve (Myoglobinuria)

Haematuria

• Drugs: Amphotericin, warfarin, sulphonamides
• Renal (Upper GU tract and kidney):
  • Tumour: Renal cell carcinoma
  • Infection: Pyonephrosis, pyelonephritis
  • Renal Lithiasis (stones)
  • Glomerular:
    • Glomerulonephritis (Berger (IgA, post strep, other))
    • Nephrotic syndrome, acute nephritis, PCK syndrome, Lupus, Alport
  • Non-Glomerular
    • Pyelonephritis
    • Papillary necrosis (NSAID, DM, sickle cell disease)
    • Vascular (Goodpastures, HSP, aortocaval fistula)
    • Malignancy (Wilms, RCC)
    • TB
• Lower GU tract (ureters, bladder)
  • Any location: Post trauma, post procedure, stones and tumour
  • Lithiasis (stones)
  • Tumour: Carcinoma of bladder, prostate
  • Bladder: TCC, Schistosomiasis, Chemical, emphysematous cystitis
  • Prostate: STD, prostatitis. BPH
• Haematological:
  • Anticoagulation
  • Sickle cell disease
  • Primary coagulopathy
• Liver: Cirrhosis (impaired PT)
• CVS: SBE
• Other:
  • Chronic infection, sulphonamides
  • Malignant hypertension
  • Renal vein thrombosis
  • Exercise induced
  • Loin-pain haematuria

Investigation

Depends on potential source

BEDSIDE:

• Urinalysis (dipstick)
  • Sensitivity: 86-100%
  • Specificity: 65-99%
  • False +ve: 10-15% (Hb, myoglobin)
    • Menstruation/PR Blood and Poor technique

LABORATORY

• Urinalysis (MCS)
  • Abnormal number of red cells per high power field (>3-5)
  • Red cell morphology (glomerular or non-glomerular)
  • Proteinuria (usually associated with GN, not just red cells)

RADIOLOGY

• Plain Radiology: KUB (AXR demonstrating Kidney, Ureter and Bladder)
• CT: CT KUB
• IVP: Intravenous pyelogram
• USS:

References:

McDonald MM, Swagerty D, Wetzel L. Assessment of microscopic hematuria in adults. Am Fam Physician 2006;73:1748-54

Renal Association. Haematuria (UK CKD eguide)

Diagnostic Imaging Pathway: Renal Colic

Diagnostic Imaging Pathway: Painless Microscopic Haematuria

Diagnostic Imaging Pathway: Painless Macroscopic Haematuria

Australian Dr: Microscopic Haematuria [PDF]

Feld LG, Waz WR, Perez LM, Joseph DB. Hematuria: an integrated medical and surgical approach. Pediatr Clin North Am 1997;44:1191-210

O’Keeffe SA, McNally S, Keogan MT. Investigating painless haematuria. BMJ 2008;337:a260, doi:10.1136/bmj.a260

BMJ 10 minute Consultation: Haematuria BMJ 2009;338:b1324