DR.MUGALO E.L.

DEFN. The presence of blood in urine

CLASSIFICATION.
 Glomerular.
 No-glomerilar medical.
 Non-glomerular surgical.

NB.proteinuria and RBC casts aids to identify

glomerular haematuria.
 lgA nephropathy
 Mesangiproliferative glomerulonephritis
 Focal segmental glomerulonephritis
 Familial nephritis (Alport’s)
 Membranous glomerulonephritis
 Systemic Lupus erythromatosus
 Sub acute bacterial endocarditis
 Blood dyscracias(haemohilia)
 Thrombocytopenia
 Sickle cell disease
 Urolithiasis
 Polycystic renal disease
 Papillary necrosis
 Reno vascular disease
 lnfections(bacteria,TB)
 Schistomiasis
 Drugs (anticoagulants, cyclophosphamide,

penicillamine)
 Exercise-induced haematuria
 Renal cell carcinoma (adenocarcinoma)
 Urothelia tumour
 Prostate(BPH, Ca prostate)
 Urolithiasis
 Trauma
 Pyridium,sulfamethoxazole,nitrofurantoin,ib
uprifen,phenytoin,levodopa,methyldopa,qui
nine,chloroquin,phenacetin.
 Painless-neoplasm in the urinary tract.
 Total-highly suggestive of bladder tumuor
 Initial/Terminal-Bladder
base,neck,prostate,urethra
 H/o mild trauma-suggests congenital
abnormalities within renal tract
 With loin pain-bleeding renal tumour,cystic
D’se/hydronephrosis,colic due to clot/calculi
 Fever, rigors-infective aetiology.
 LUTS-r/o Boo
 Occupational Risks-exposure to carcinogens
eg,aniline dyes,2-naphthylamine,acrolein
used in chemical and textile industries.
 Painters,metal workers,dry
cleaners,barber,hair-dressers dye and
rubber industriea,cigarrette smocking.
 Family h/o renal d’se-familial nephritis,
polycystic d’se.
 Recent URTI (post streptococal

glomerulonephritis)
 Recent h/o of coagulopathy ,pupuric rash
 Full list of medication including

anticoagulants
 General exam-anaemia ,signs of bleeding
,PR,BP
 Abd Palpation-lion tenderness, enlarged
kidney, palpable bladder/suprapubic mass
 Palpable spleen or liver-may point to
haematological cause/disinated malignancy.
 External genitalia, pelvic exam in females
and DRE in males is mandotory
 Urinalysis-mid stream specimen
mandatory to r/o infection-
dipstic,microscopy,C/S
 Urine cytology-freshly passed sample-can
pick poorly differntiated TCC and
Carcinoma-in –situ NB. Low specificity and
sensitivity particularly in the presence of
inflammatory disease with detection rates
50%-60%.
 Other urine markers-BTA (bladder tumour
antigen,NMP22(nuclear matrix protein
22),Fibrinagen degradation products
 Renal function
 Blood tests. BUN,Creatinine,PSA(in older
men) ,CBC with
differentials,platelets,PT,PTT,Bleeding time
if indicated.
 UPPER TRACT IMAGING.
 CT Urogram (higher sensitivity)OR
 Combination of IVU and renal US.
 Cystoscopy/Ureteroscopy
 If work-up is normal-look for minor tumour
markers in the urine and blood pressure at
6,12,24, and 36 months later espaecialy for
high risk patients(ie >40 years), voiding
symptoms,smockers,chemical
exposure,gross haematuria and other
urologic diseases.
 If work-up is negative after 36 months there

may be no need for furher evaluation.

 In case of renal
insufficiency,hypertension,significant
hematuria,RBC casts,or dismorphic RBCs in
urine,-refer to nephrologist for work-up fo
parenchymal disease.
 Treat underlying cause.
 Stop NSAIDs,heparin,warfarin and other

anticoagulants
 If anemic-consider transfision.
 3-way hematuria catheter placement-

-irrigate and evacuate blood clots from

bladder
-light traction on the catheter if bleeding is
from the prostate
-continous irrigation with N/saline.
 1.Renal bleeding a).embolization, b)Partial
or total nephrectomy.
 2.Prostate bleeding a).aminocaproic acid

b).androgen deprivation c).5α-reductase

inhibitors d).prostate surgery-
electrocautery,TURP,openprostatectomy
e)prostate radiation
 3.Bladder bleeding-a)aminocaproic

acid,b),transurethralelectrocautery,c)intrave
sical agents eg,alum,formalin,phenol used
eg in radiation cystitis when entire bladder
surface is involved.
 Bladder bleeding-d),Hyperbaric oxygen –
used for hemorrhagic cystitis caused by
radiation or chemotherapy,e)diverting urine
with nephrostomy tubes-hemorrhage stops
within one week,f),embolization or ligation
of internal iliac arteries,g)Cystectomy