A traditional approach to quantifying hematuria is by counting the total number of rbcs in a timed 12 hour urine sample. This article provides information on common and less common causes of hematuria, diagnostic considerations, and disposition algorithms to aid patients. Visible gross hematuria is urine that is visibly discolored by blood or blood clot. Although the differential diagnosis for hematuria is extensive, most cases are isolated and benign. Hematuria in adults approach to hematuria identify origin of the blood glomerular hematuria micro or macroscopic abnormal morphology proteinuria, active sediment may be familial check first degree relatives look for hearing loss nonglomerular hematuria micro or macroscopic normal morphology isolated finding. In the majority, a good clinical examination and basic investigations including a urine microscopic. Hematuria and proteinuria are common findings in primary care practice. Assessment of asymptomatic microscopic hematuria in adults. Hematuria is the medical term for red blood cells in the urine. Microscopic hematuria in the setting of urinary tract infection should resolve after. See evaluation of microscopic hematuria in children and evaluation of gross hematuria in children. The timing of hematuria in the urinary stream is important. Hematuria is identified by taking a patient history and by performing a routine urine dipstick test.
Persistent hematuria macroscopic or microscopic should be evaluated to determine the source of bleeding and the. Another study of the same primary care database took a similar approach. Establish the presence of true haematuria the presence of haematuria is easily established in patients with macroscopic bleeding but beware of other causes of red urine see table 1. Urinary dipsticks are very sensitive and can be positive at haematuria haemoglobinuria, myoglobinuria, medication, and food. An approach to the investigation and initial management of macroscopic. Hematuria jeff kaufhold, md 6 march 2016 gross hematuria is visible blood in the urine. This article looks at the role of the general practitioner in the investigation and initial management of macroscopic haematuria. Nevertheless, an orderly, comprehensive approach can greatly simplify the diagnosis.
The most important test in the evaluation of hematuria is a microscopic examination of the urine. If it looks like you could run a hematocrit on it, the cause is always structural see causes of hematuria, nonglomerular. Pdf causes of hematuria can range from benign conditions such as. Macroscopic haematuria is blood in the urine which is visible to the naked eye, whereas microscopic haematuria is blood identified on dipstick analysis. Hematuria is a common finding in children and often comes to the attention of the pediatrician as a result of a routine screening urinalysis, as an incidental finding when evaluating urinary tract symptoms, or when a child has gross hematuria. Haematuria is a common symptom with a multitude of differentials.
The dipstick relies on oxidation of an organic peroxide on the test strip by the peroxidaselike activity of hemoglobin. Management of macroscopic haematuria in the emergency. This document will continue to be periodically updated to reflect the growing body of literature. Red blood cells rbcs in the urine are required for a diagnosis of hematuria. It can present as macroscopic hematuria or microscopic hematuria due to either glomerular or nonglomerular disorders. It is a common symptom of both benign and malignant conditions. It may be idiopathic and or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract kidneys, ureters, urinary bladder, prostate, and urethra, ranging from. Aproach to hematuria urinary tract infection kidney.
Hematuria that is not explained by an obvious underlying condition eg, cystitis. Approach to hematuria is the property of its rightful owner. Macroscopic haematuria a urological approach racgp. Approach to the child with hematuria pediatric clinics of north. What is significant hematuria for the primary care physician. Although more research is needed to resolve certain controversies in management, the suggested approach aims to detect major or. Racgp macroscopic haematuria a urological approach.
Assessment of microscopic hematuria in adults mary m. Approach to hematuria systemic lupus erythematosus. Red blood cells in the urine can come from the kidney where urine is made or anywhere in the urinary tract. An evidencebased approach to the management of hematuria. Hematuria is a common finding in children and adolescents, often causing significant anxiety and prompting an extensive evaluation. There is no specific treatment to resolve or prevent hematuria. Management and appropriate follow up of haematuria are considered in this podcast. Canadian guidelines for the management of asymptomatic microscopic hematuria in adults. The presence of 10 or more rbcs per highpower field is abnormal. Guidelines for the management of a child with haematuria. Persistent microscopic hematuria indicates the presence of a renal disease that warrants close monitoring and evaluation. History the evaluation of hematuria should always begin with a detailed history. The approach to the patient with hematuria emergency medicine.
Approach to hematuria welcome to association of physicians of. Gross hematuria can vary widely in appearance, from light pink to deep red with clots. Haematuria on dipstick haematuria can be classified as visible, also known as macroscopic or gross haematuria, or nonvisible, also known as microscopic haematuria. If so, share your ppt presentation slides online with. It is typically detected by dipstick urinalysis, an ordinary, noninvasive test. Haematuria is the presence of red blood cells in the urine.
As little as 1 ml of blood can impart color to 1 liter of urine. Hema turia can be either macroscopic or microscopic. Sunil agrawal 1st year md pediatrics, iom slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Aproach to hematuria free download as powerpoint presentation. Symptoms, causes, diagnosis and treatment hematuria, or blood in the urine, can be either gross visible or microscopic blood cells only visible through a microscope. Haematuria is defined as evidence of blood in the urine. We discuss the common causes of hematuria and how to evaluate it. Resolution of hematuria usually occurs with appropriate management of the underlying disorder. Hematuria may be visible to the naked eye called gross hematuria or detectable only on examination of the urine sediment by microscopy called microscopic hematuria. However, most importantly, macroscopic haematuria has a high diagnostic yield for urological malignancy. Hematuria is defined as 25 rbcs per hpf in urine microscopy. Hematuria is a common finding in primary care practice. Although the american academy of pediatrics eliminated routine urine screening from its preventive care guidelines a decade ago, many pediatricians continue to use screening urinalysis.
Had so much fun filming this and doing all the nonsense. 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. In contrast, patients with glomerular disease excreted 40120 million rbcs. The us and canadian guidelines take a pragmatic approach here. Evaluation of visible hematuria differential diagnosis. Canadian guidelines for the management of asymptomatic. A careful assessment is required to determine the need for further testing or referral to a specialist. Hematuria is one of the alarming manifestations of a renal disease. Etiology and evaluation of hematuria in adults uptodate. Ppt hematuria powerpoint presentation free to download. Microscopic hematuria is defined as presence of three or more red blood cells rbcs per highpower field. Proteinuria is a common incidental finding in adult primary care pracrenal diseases abstract approach to proteinuria in adults and elderly proteinuria can create one of the greatest challenges in primary practice, especially in the geriatric population. Haematuria is a common call junior doctors are asked to assess on the wards.
Key points even if a dipstick test for hematuria is positive, a key. This article looks at the role of the general practitioner in the investigation and initial. Common urological causes of haematuria include urinary tract infection and ureteric and renal stones, but. Be the end of this lecture the student is should be able to evaluate a child with hematuria considering the following. Razan haj definition presence of rbc in urine either. If you continue browsing the site, you agree to the use of cookies on this website. 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. Macroscopic haematuria a urological approach melissa yeoh nai kid lai daniel anderson vinesh appadurai haematuria is defined as evidence of blood in the urine under microscopy. In this article, we provide an overview of the causes of hematuria and of the. When microscopic hematuria without proteinuria is found as an incidental finding, significant pathology is rarely identified. Approach to a child with hematuria mohamed waheed elsharief mbbs, msc md. An algorithmic approach to the diagnosis and management of microscopic hematuria is.
Pdf evaluation and management of hematuria researchgate. Clinical presentation and urine microscopy can differentiate glomerular from nonglomerular hematuria. An evidencebased approach to the management of hematuria in children in the emergency department an evidencebased approach to the management of hematuria in children in the emergency department. Evaluation of visible hematuria approach bmj best practice. Approach to a child with hematuria d d authorstream. Microhematuria pdf this document was amended in july 2016 to reflect literature that was released since the original publication of this content in may 2012. Haematuria is a clinical condition where there is presence of frank blood or rbcs in the urine. Normals excreted a mean of 66,000 rbcs with a range of 0425,000. Assessment of asymptomatic microscopic hematuria in adults aafp. On centrifugation of the urine specimen the sediment is red in haematuria whereas the supernatant is red. Hematuria in adults approach to hematuria identify origin of the blood glomerular hematuria micro or macroscopic abnormal morphology proteinuria, active sediment may be familial check first degree relatives look for hearing loss nonglomerular hematuria micro or.
Visible hematuria, even when transient or asymptomatic, may indicate a significan. It may present as urine that is red to brown, or as frank blood. Causes of significant hematuria include urinary tract infection, urolithiasis, malignancies, benign prostatic hyperplasia, and nephropathies. Hematuria indicates the presence of urogenital disease in dogs and cats. Many tests have been recommended for the child with hematuria, but no consensus exists on a stepwise evaluation. Ppt approach to hematuria powerpoint presentation free. Macroscopic haematuria is a commonly seen condition in the emergency department ed, which has a variety of causes. Assessment of microscopic hematuria in adults aafp. If significant pathology is suspected, a logical approach to this common pediatric issue should be pursued. Padmaja assistant professor professor and chief dr.
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