Microscopic Hematuria

HISTORY:

Presents for ‍newknown microscopic hematuria



Lab results:

Urinalysis: RBC ‍, leukocytes ‍ ‍-, nitrites ‍+-, Proteins ‍ ‍-,

Hb ‍ ‍normal

Creatinine ‍ ‍normal

PSA ‍ ‍normal



Associated symptoms: *Try using right-click for negatives*

‍gross hematuria

‍dysuria

‍urgency

‍foul-smelling urine

‍suprapubic pressure

‍abdominal pain

‍flank pain

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍nausea

‍vomiting

‍hesitancy

‍nocturia

‍rectal bleeding, ‍oncetwice ‍, ‍bright reddark red, ‍withwithout clots

‍genital trauma

‍current menstrual period

‍vaginal bleeding



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Anorectal: DRE ‍normal, prostate ‍normal, anus ‍normal

Genital: ‍normal, testicles ‍normal, penis ‍normal

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness



ASSESSMENT:

‍Microscopic hematuria ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍BUN, ‍CRP, ‍coagulation profile

- Urine: ‍urinalysis, ‍urine culture, ‍urine cytology

- Renal ultrasound

- CT pyeloscan

- Cystoscopy

- ‍Antibiotics if infection suspected

- ‍Analgesics if pain present

- Increase fluid intake

- Avoid NSAIDs

- Referral to urologist

- Referral to nephrologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop

- Go to ER if severe pain, fever, or inability to urinate occurs