The color change does not necessarily reflect the degree of blood loss, since as little as 1 ml of blood per liter of urine can induce a visible color change. Approximately 10 ml of mid stream urine should be collected and imme diately centrifuged at 2,000 revolutions per minute for 10 minutes the number of revo lutions and minutes may vary, depending on the centrifuge. Approach to hematuria free download as powerpoint presentation. Hematuria may be asymptomatic or symptomatic and may be. Always take your antibiotics exactly as ordered by your healthcare provider.
Ppt approach to hematuria powerpoint presentation free. In most patients, a further evaluation is warranted. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. It can be caused by a bleeding disorder or certain medications, or by stones, infection, or tumor. In contrast, patients with glomerular disease excreted 40120 million rbcs. Asymptomatic microscopic hematuria in adults canadian guidelines for the management of asymptomatic microscopic hematuria in adults tim wollin, md, frcsc.
Approach to hematuria systemic lupus erythematosus organ. Jun 11, 2014 haematuria or hematuria is defined as the presence of erythrocytes in the urine. If hematuria is secondary to a kidney stone, then management depends on the size of the kidney stone. An illustrative diagnosticmanagement tree on evaluating hematuria. A traditional approach to quantifying hematuria is by counting the total number of rbcs in a timed 12 hour urine sample. Hematuria is the condition of having blood in the urine. Microscopic hematuria refers to the detection of blood on urinalysis or urine microscopy. Feb 03, 2020 some common causes of hematuria are bladder infection, kidney stone, trauma to the kidneys or bladder, and some medications.
Check out this lesson to learn more about hematuria, including the causes, symptoms and treatment. Hematuria that is not explained by an obvious underlying condition eg, cystitis, ureteral stone is fairly common. Algorithm for the diagnosis and management of incidentally discovered microscopic hematuria. Sometimes blood clots can block the urethra so that you cannot empty your bladder. An algorithm for the evaluation of essential hematuria. Joseph mercy hospital objectives describe the evaluation and management of gross hematuria describe the evaluation and management of microscopic hematuria case presentation 34 year old female presents with depression and suicidal. Hematuria is the presence of red blood cells in the urine. Mar 10, 2016 this recommendation statement from the acp provides clinicians with a rational approach to evaluating hematuria. On the other hand, there is an appreciable risk of malignancy in older patients eg, over age 35 years with hematuria, even if transient. Hematuria is defined as 25 rbcs per hpf in urine microscopy.
A 56yearold male, with a previous medical history of smoking 30 pack years and chronic obstructive pulmonary disease budesonide, presents to the emergency department for three days of painless hematuria. Hematuria is a common finding in children and adolescents, often causing significant anxiety and prompting an extensive evaluation. This recommendation statement from the acp provides clinicians with a rational approach to evaluating hematuria. If white blood cells are found in addition to red blood cells, then it is a signal of urinary tract infection. The urinary tract includes the ureters the tubes that carry the urine from the kidneys to the bladder, the bladder where urine is stored, the prostate in men, and the urethra the tube. In this article, we provide an overview of the causes of hematuria and of the. Macroscopic hematuria occurs when the quantity of blood in urine is visible to the naked eye eg, pink, red, dark brown in color. Isolated hematuria merck manuals professional edition. Red or brown colacolored urine with red blood cells rbcs seen on microscopy is typical of macroscopic or gross hematuria. Bloody urine may be caused by abnormalities in the urinary tract or by disease processes elsewhere in the body that can affect the urinary tract. When the blood in urine is visible, then it is called gross hematuria. Hematuria is termed microscopic when the urine is visually normal in color but is found to contain blood on chemical analysis or microscopic evaluation. Assessment of microscopic hematuria in adults mary m.
Hematuria can be either gross ie, overtly bloody, smoky, or teacolored urine or microscopic. Canadian guidelines for the management of asymptomatic. Microscopic hematuria is defined as presence of three or more red blood cells rbcs per highpower field. The most important test in the evaluation of hematuria is a microscopic examination of the urine. Approach to hematuria systemic lupus erythematosus. The purpose of this guideline is to provide a clinical framework for the diagnosis, evaluation, and followup of asymptomatic microhematuria amh. Management of hematuria is aimed at treating secondary causes of hematuria.
Renal causes include acute glomerulonephritis, renal infarction, embolism of the renal artery, tubular damage from toxic insult, and pyelonephritis. A 56yearold male, with a previous medical history of smoking 30 pack years and chronic obstructive pulmonary disease budesonide, presents to the emergency department for. Approach to hematuria association of physician of india. Approach to a child with hematuria mohamed waheed elsharief mbbs, msc md. Hematuria may be the initial manifestation of significant genitourinary disease although in many cases a diagnosis is not established even after consultation with a specialist. Evaluation of hematuria rodney smith, md university of michigan department of emergency medicine st. The first episode occurred a few days after the onset of a uri. Gross hematuria at the end of life constitutes a highly distressing complication for patients and families. It also highlights studies that show that, among patients with documented hematuria, women have lower rates of urology referral and higher rates of incomplete diagnostic evaluation than do men.
Haematuria is defined as evidence of blood in the urine. Hematuria or blood in urine hematuria is blood in the urine. The effective management of hematuria requires a careful evaluation in the elderly patient. If so, share your ppt presentation slides online with. Hematuria causes range from being negligible to lethal malignancy. Asymptomatic hematuria requires obtaining a thorough history, which includes common risk factors for urinary tract malignancy, physical exam, and laboratory evaluation. Polypoid cystitis is an uncommon disease in dogs characterized by proliferation of the bladder mucosa, which can cause thickening of the bladder wall, papillarylike projections from the mucosal surface, and polyps that extend into the bladder lumen. Microscopic hematuria is characterized by small numbers of rbcs in urine and is only visible during microscopic examination of urine sediment. Having blood in your urine doesnt always mean you have a medical problem.
Hematuria may be an indication of a serious blood clotting or platelet disorder. Hematuria is usually defined as more than 5 red blood cells per highpower field in the uri nary sediment, although the definition is vari able. Macroscopic haematuria a urological approach racgp. Hematuria is red blood cells rbcs in urine, specifically 3 rbcs per highpower field on urine sediment examination. On the other hand, hematuria may also be a sign of some serious condition. Hematuria at the start of urination suggests a problem with the distal urethra. Proteinuria hematuria history of kidney disease hypertension fever, exertion history of kidney disease history of urinary stone disease use of certain medications including analgesic and anticoagulants those who perform strenuous activities recent viral. Postrenal hematuria occurs particularly in urolithiasis and.
Blood in the urine national kidney and urologic diseases information clearinghouse. However, even among older patients, a urologic cause for the hematuria can often not be identified 61 percent in a series of 1930 patients referred to a hematuria clinic. In addition to checking an inr, it is important to investigate benign causes for the hematuria. Hematuria at the start of urination suggests a problem with the distal urethra, while hematuria at the end of urination suggests a problem with the bladder neck, posterior urethra, or prostatic urethra in men. Red blood cells in the urine can come from the kidney where urine is made or anywhere in the u. Facts about blood in urine hematuria general center. Approach to hematuria is the property of its rightful owner. Key points even if a dipstick test for hematuria is positive, a key. The urinalysis in nonglomerular medical and surgical hematuria is similar in that both are characterized by circular erythrocytes and the absence of erythrocyte casts 12. Approach to hematuria kidney urinary tract infection. Microscopic hematuria small amounts of blood can be seen on light microscopy or urinanalysis. Approach to a child with hematuria d d authorstream. We discuss the common causes of hematuria and how to evaluate it. Gross hematuria gross hematuria is suspected because of the presence of red or brown urine.
Hpi 57yo man with a c6 spinal cord injury with quadriplegia bladder managed with indwelling foley catheter changed monthly went to pcp after noticing blood in the urine sent to er and admitted to the hospital urine culture showed 3 or more organisms. Incidence of hematuria with bph reported to be as high as 12% bph causing gross hematuria requiring transfusions occurs hematuria is red blood cells rbcs in urine, specifically 3 rbcs per highpower field on urine sediment examination. False positive dip stick in myoglobinuria and hemogobinuria 3. The timing of hematuria in the urinary stream is important. Haematuria is the presence of macroscopic andor microscopic red blood cells in the urine forrester 2004. The us and canadian guidelines take a pragmatic approach here. This medicine is given to fight or prevent an infection caused by bacteria. Haematuria is a common symptom with a multitude of differentials. Nevertheless, an orderly, comprehensive approach can greatly simplify the diagnosis. Haematuria or hematuria is defined as the presence of erythrocytes in the urine. Generally, 1ml blood in 1l urine can cause visible urine discoloration and is alarming to patients, which is termed gross, frank, or macroscopic hematuria. In many such patients, particularly young adult patients, the hematuria is transient and of no consequence. This can be mimicked by myoglobin, povidoneiodine, h 2o 2, bacterial peroxidases.
Hematuria is the medical term for red blood cells in the urine. Microscopic hematuria can only be seen by the means of a microscope and is usually diagnosed when the urine test is performed. Hematuria is a condition that causes blood to be excreted in the urine yikes. Diagnostic approach to hematuria in dogs and cats request pdf. Hematuria, presence of blood in the urine, an indication of injury or disease of the kidney or some other structure of the urinary tract. The blood may become apparent during urination or only upon microscopic examination. If hematuria is a result of a uti, treatment with antibiotics is usually initiated and urine testing repeated after 6 weeks. Hematuria is defined as the presence of red blood cells in the urine. However, the evaluation of urinary stones is an aspect of the patient taken as a whole. Normals excreted a mean of 66,000 rbcs with a range of 0425,000. Hematuria american academy of pediatrics textbook of. The evaluation of hematuria should always begin with a detailed history. History the evaluation of hematuria should always begin with a detailed history. Acute hematuria discharge care what you need to know.
The dipstick relies on oxidation of an organic peroxide on the test strip by the peroxidaselike activity of hemoglobin. Hematuria can be from prerenal causes when vascular damage occurs, such as trauma to the kidney, septicemia, and purpura hemorrhagica. Approach to hematuria confirm true hematuria false positive dipstick. Currently available data are insufficient to determine an algorithm based on evidence of the most effective diagnostic strategy of hematuria. Assessment of asymptomatic microscopic hematuria in adults.
Hematuria 10% or more have benign hematuria or hematuria of unknown cause symptom of bladder cancer, kidney cancer, infection, stones, etc. Microscopic hematuria is common in medical practice. It may be due to injury to the kidneys, urinary tract, prostate, or genitals. Blood that can be seen in the urine is called gross hematuria. Ppt approach to hematuria powerpoint presentation free to.
Ask about these or other medicines you may need to treat the cause of your acute hematuria. Department of health and human services national institutes of health. Hematuria may manifest as a dramatic change in the color of a childs urine, with the appearance of blood on a diaper or underwear, or as a finding on a urinalysis. Red blood cells in the urine can come from the kidney where urine is made or anywhere in the urinary tract. To provide best supportive care in these cases, clinicians must combine skills in medical and nursing management, communication and clarification of patient goals, and relief of symptom burden. Karen psooy, md introduction microscopic hematuria is a frequent reason for referral to urology. Do not stop taking your medicine unless directed by your healthcare provider. Hematuria is termed gross, or macroscopic, when there is sufficient blood present to color the urine red or brown. The exception to this is the young woman with hematuria, signs and symptoms of uncomplicated cystitis, and a positive urine culture. Hematuria in the adult as in children, the laboratory evaluation of hematuria in the adult begins with a urinalysis and urine culture algorithm 1. The patient was otherwise healthy, had no complaints, no significant pmh and physical exam was unremarkable including a normal blood pressure on no medications. Padmaja assistant professor professor and chief dr.
Generally, hematuria is defined as the presence of 5 or more red blood cells rbcs per highpower field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. Be the end of this lecture the student is should be able to evaluate a child with hematuria considering the following. Hematuria vs pigmenturia discoloration of urine hematuria vs hemoglobinuria and myoglobinuria 4. Generally, 1ml blood in 1l urine can cause visible urine discoloration and is alarming to patients, which is.