Transcript Definition,causes of heme-negative red urine,differential diagnosis

This lecture was conducted during the Nephrology Unit Grand
Ground by Medical Student under Nephrology Division under
the supervision and administration of Prof. Jamal Al Wakeel,
Head of Nephrology Unit, Department of Medicine and Dr.
Abdulkareem Al Suwaida, Chairman of Department of
Medicine and Nephrology Consultant. Nephrology Division is
not responsible for the content of the presentation for it is
intended for learning and /or education purpose only.
Presented By:
Abdulmajeed Alahmari
Medical Student
2009
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Bloody urine
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Gross hematuria
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Microscopic hematuria
◦ 3 or more RBC’s per high power field in spun urine
sediment
Medications
Food dyes
Metabolities
Doxorubicin
Beets (in selected
patients)
Bile pigments
Chloroquine
Blackberries
Homogentisic acid
Deferoxamine
Food coloring
Melanin
Ibuprofen
Methemoglobin
Iron sorbitol
Porphyrin
Nitrofurantoin
Tyrosinosis
Phenazopyridine
Urates
Phenolphthalein
Rifampin
Glomerular
ARF
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primary nephritis (post streptococcal glomerulonephritis , Ig A
nephropathy , Anti-GBM disease)
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2nd nephritis (SLE, goodpasture’s syndrome, ANCA related vasculitis)
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Alport’s syndrome (hereditary nephritis)
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thin basement membrane nephropathy (benign familial hematuria)
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Renal Causes :
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malignancy
vascular disease
sickle cell trait/disease, papillary necrosis
infection (pyelonephritis, TB, CMV, EBV)
hypercalciuria
hereditary disease (polycystic kidney disease )
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Non-renal causes :
malignancy (prostate, ureter, bladder)
BPH
Nephrolithiasis
Coagulopathy
Trauma
Isolated hematuria
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No other urinary abnormalities
No renal insufficiency
No evidence for systemic disease
Glomerular
- Benign Recurrent or Persistent Hematuria
1.Sporadic
2.Familial
- IgA Nephropathy
- Alport syndrome
- PSAGN
Non-glomerular
- Idiopathic Hypercalciuria
- Cystic Kidneys
- Urinary Tract obstruction
- Tumors
- Trauma
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Thorough history and physical exam
◦ Any clues that point to particular diagnosis?
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Is hematuria transient or persistent?
◦ Repeat UA in a few days to determine
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Is it glomerular or extraglomerular bleeding?
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Urine is red, smoky
brown or “cocacola”
Clots absent
Proteinuria >500
mg/day
Dysmorphic RBC’s
RBC casts are
present
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Red or pink urine
Clots may be
present
<500 mg/day
proteinuria
Normal RBC
RBC casts may be
present
Dysmorphic
erythrocytes suggest
hematuria of
glomerular origin.
History
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Age
Time of hematuria
Abdominal or flank pain
Dysuria, frequency, urgency
Trauma
Strenuous exercise
Menstruation
Recent URI/ sore throat
Skin rashes
Joint pains/swellings
Drug history
(analgesics, NSAID,
chemotherapy agents)
Coagulopathy
Family history
Alport’s syndrome
of PCKD or
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Vital signs, esp. BP
Flank tenderness
Edema
Cardiac murmur
Hemoptysis
Suprapubic discomfort
Genitourinary exam
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Urinalysis ( bacteria , pH, protein,, cast )
Glomerular: RBC casts, RBC dysmorphism,
Non-glomerular : Intact RBC
U/C, BUN, Cre, CBC
Anticoagulation study
Immunologic profiles
Non-glomerular causes
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CT, renal US, and/or IVP: to search for lesions in
the kidney, collecting system, ureters, and bladder
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Urine cytology: if increased risk for urothelial
cancers
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Consider a referral to urology for cystoscopy,
especially for pt at risk of malignancies
Thank you