USMLE Forum Archives - USMLE Step 3 - Workup of Hematuria
Workup of Hematuria
harry206 - 05-03-09 08:25
Hematuria:
• First step in hematuria ----> Urinanalysis
• Urinalysis confirms the presence of hematuria, and differentiates extraglomerular hematuria from glomerular hematuria. ----> Red cell casts, dysmorphic red cells, and associated proteinuria are features of glomerular bleeding. Centrifugation of urine allows distinction between hematuria, hemoglobinuria, and myoglobinuria.
• Patients with glomerular bleeding should be referred to a nephrologist, who will decide if a renal biopsy is required or not
• All patients with unexplained extraglomerular hematuria should undergo further radiological studies to localize the lesion of kidney, collecting system, ureter, or bladder. -------> Intravenous pyelogram (IVP) is usually the first imaging modality of choice. It is superior to renal ultrasound for better detection of medullary sponge kidney and lesions in the renal pelvis and ureters.
Young patients with normal IVP does not require further imaging;
However, older patients with normal IVP should be followed by ultrasound or helical CT for the detection of possible malignancy.
Older patient with painless hematuria &risk factor---> cystoscopy
Note: IVP is superior to detect upper urinary tract malignancy (but C/I in renal failure) and cystoscopy for lower urinary tract.
harry206 - 05-03-09 08:25
Hematuria:
• First step in hematuria ----> Urinanalysis
• Urinalysis confirms the presence of hematuria, and differentiates extraglomerular hematuria from glomerular hematuria. ----> Red cell casts, dysmorphic red cells, and associated proteinuria are features of glomerular bleeding. Centrifugation of urine allows distinction between hematuria, hemoglobinuria, and myoglobinuria.
• Patients with glomerular bleeding should be referred to a nephrologist, who will decide if a renal biopsy is required or not
• All patients with unexplained extraglomerular hematuria should undergo further radiological studies to localize the lesion of kidney, collecting system, ureter, or bladder. -------> Intravenous pyelogram (IVP) is usually the first imaging modality of choice. It is superior to renal ultrasound for better detection of medullary sponge kidney and lesions in the renal pelvis and ureters.
Young patients with normal IVP does not require further imaging;
However, older patients with normal IVP should be followed by ultrasound or helical CT for the detection of possible malignancy.
Older patient with painless hematuria &risk factor---> cystoscopy
Note: IVP is superior to detect upper urinary tract malignancy (but C/I in renal failure) and cystoscopy for lower urinary tract.
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#1
Re: Workup of Hematuria usmlefever3 - 05-03-09 10:55 thanks for the wonderful compilation of information
#2
Re: Workup of Hematuria meduploader - 05-03-09 11:42 Is great effort bro.
waiting for the same in proteinuria.Hope it will come soon too.
#3
Workup of Proteinuria
harry206 - 05-03-09 13:28 On Meduploader's Request :)
Workup of Proteinuria:
To determine the cause of proteinuria, it is important to know the quantity and type of protein involved. To determine this, proceed as follows
â– Obtain a 24-hour urine collection to quantify daily urinary protein excretion;
if this is not possible, check a urine protein/creatinine ratio (normal is < 0.2; nephrotic syndrome is > 3.0)
â– Check a UA, electrolytes, BUN/creatinine, urine protein electrophoresis, and serum total protein.
â– Examine urine sediment: A benign appearance suggests benign causes, while red cells and casts suggest acute nephritic syndrome, and fat bodies point to nephrotic syndrome. (Note the difference between nephritic and nephrotic syndromes.)
â– A UA significant only for protein in the absence of other signs of renal disease suggests benign proteinuria. Causes include pulmonary edema, CHF, fever, exercise, head injury, CVA, stress, orthostatic proteinuria, and idiopathic factors.
Interstitial nephritis
< 2 g/24 hours
Routine UA shows WBCs, WBC casts, and eosinophils.
Infection, medications (NSAIDs, quinolones, sulfonamides, rifampin), Connective tissue diseases (SLE, sarcoidosis, Sjögren’s syndrome)
Glomerular disease
> 2 g/24 hours
Routine UA shows RBCs or RBC casts.
Overflow proteinuria
< 2 g/24 hours; mostly light-chain or low-molecular-weight proteins.
Amyloid, multiple myeloma, lymphoproliferative disease, proteins, hemoglobin, myoglobin
#4
Re: Workup of Hematuria meduploader - 05-03-09 13:44 thanks for the wonderful compilation of information
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