Haematuria: overview

I had an OSCE station on microscopic haematuria. I didn't really know how to approach, hence, this post on some key facts and checkpoints. Most of this is from John Murtagh's text book and some Australian guidelines.

Key points:

1. Macroscopic haematuria is always abnormal except in menstruating women.

2. Joggers and athletes engaged in very vigorous exercise can develop transient microscopic haematuria.

3. Microscopic (asymptomatic haematuria) can be classified as either:

•  glomerular (from kidney parenchyma): common causes are IgA nephropathy and thin membrane disease
• non-glomerular (urological): the common causes are bladder cancer, benign prostate hyperplasia and urinary calculi

4. 20 % of people with visible haematuria have cancer

5. It is important to exclude kidney damage, so patients should have blood pressure, urinary protein and plasma creatinine levels measured as a baseline and urine red cell cast

6. The possibility of sexually acquired urethritis should be kept in mind

7. Painful haematuria is suggestive of infection, calculi or kidney infarction.

8. Painless haematuria is commonly associated with infection, trauma, tumours or polycystic kidneys

9. A drug history is relevant, especially with anticoagulants and cyclophosphamide. A diet history should also be considered

10. There is no consensus guideline on what imaging test you should request, WA health has developed imaging pathway online and it is free for everyone to access: painless haematuria

11. Key questions (adopted from General Practice by John Murtagh)

• Have you had injury?
• Have you noticed whether the redness is at the start or end of your stream or throughout the stream?
• Bleeding elsewhere?
• Abdominal or loin pain?
• Burning or frequency of your urine?
• Problems with the flow of your urine?
• Have you having large amounts of beetroot, red lollies or berries in your diet?
• Could your problem have been sexually acquired?
• Recent strenuous exercise
• Any kidney problems in the past?

12. Presence of haematuria should not be contributed to anticoagulants or anti platelets, further evaluation is required. (3)

References:

1.  General Practice by John Murtagh
2. WA imaging pathway
3. General practice notebook