Haematuria

• frank

  • 25% have life-threatening condition

•  vs microscopic

  • in women under 40 <2% chance of serious problem

Causes

• Not worrying

  • strenuous exercise

  • urinary tract instrumentation

  • menstruation

• Tumours

  • Typically Painless

  • Transitional Cell Carcinoma

  • Renal Cell Carcinoma

• Stones

• Infection

  • Urinary Tract Infections

  • urethritis

• Bladder neck obstruction

  • from dilated veins at bladder neck when straining to micturate

  • strictures

  • Benign Prostatic Hyperplasia

• Trauma

  • enlarged kidneys may cause frank haematuria from minor trauma

• Renal parenchymal inflammation

  • glomerulonephritis (often + proteinuria)

  • arteritis

• Microemboli

• haemangiomas / arterio-venous malformations, .

False Positives

• myoglobinuria

Investigations

• MSU

  • up to 3 RBC per pigh power field normal

  • culture

• IVU

• USS

• MRI /CT

• Cystoscopy / retrograde pyelogram

• Urine cytology

  • 3x voided urine

  • not early morning as degenerate urothelial cell common

Clues to diagnosis

• Clots

  • shape may indicate origin

Follow up

• if no abnormalities then annual urinalysis and cytology for 3 years

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