Haematuria

Causes

Renal   Glomerulonephritis Pyelonephritis Tumour   Renal cell carcinoma Transitional cell carcinoma Nephroblastoma Renal infarct Anticoagulant medication Tuberculosus (TB) Polycystic kidney Ureter   Renal calculi Pyelonephritis Transitinal cell carcinoma Ureteric strictures Bladder   Cystitis Transitional cell carcinoma Prostate   Benign prostatic hypertrophy Prostate adenocarcinoma Urethra   Urethritis Urinary Tract Infection (UTI) Urethral strictures

History

Haematuria   Placement in stream   Early - urethral cause Late - bladder cause Continous - upper urinary tract Presence of clots - bladder cause Pain   Dysuria   "Burning" sensation during micturition Renal colic   Severe, colicky, flank pain Superimposed on a background of constant pain Radiates to groin Obstructive symptoms   Dysuria Poor stream Hesitancy Terminal dribbling Irritative symptoms   Dysuria Nocturia Frequency Urgency Incomplete voidance Constitutional symptoms   Lethrgy / malaise Weight loss Poor appetite Fever Discharge - Urethritis / UTI Medications - anticoagulants Smoking - predisposition to cancer

Examination

General Vitals Abdominal masses Abdominal tenderness Genital examination PR Urinalysis - Leukocytes, Erythrocytes

Investigations

MSU   Microscopy, culture and antibiotic sensitivity (MCS) Phase contrast - glomerular / non glomerular erythrocytes Bloods   FBE   Anaemia - due to blood loss Leukocytosis - indicates inflommation Thrombocytopaenia - bleeding diathesis U&E - assess renal function, obstructive uropathy PSA - indicates prostatic disease ESR / CRP - raised in infections Imaging   KUB Plain X-Ray - renal calculi U/S - renal masses, bladder masses Intravenous Pyelogram (IVP) - renal calculi Helical CT - only useful if U/S and IVP is equivical Cystoscopy ± retrograde pyelography ± biopsy