Gross Hematuria

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of gross hematuria

Described as ‍pinkbright reddark redcola-colored urine, ‍withwithout clots

Occurred ‍ times ‍per dayoverall



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

‍dysuria

‍urgency

‍foul-smelling urine

‍suprapubic pressure

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍flank pain

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍incontinence

‍hesitancy

‍nocturia



Contributing factors:

‍smoking

‍exposure to certain chemicals

‍recent strenuous exercise

‍recent consumption of foods that may mimic hematuria

no history of: ‍chronic urinary tract infections, ‍kidney stones, ‍urological cancer, ‍sickle cell disease

no use of: ‍anticoagulants, ‍aspirin, ‍clopidogrel, ‍cyclophosphamide, ‍rifampin

no family history of: ‍kidney disease

no recent ‍bladder catheters, ‍urological procedure





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Gross hematuria ‍likelysuspectedpossible

DDx: urinary tract infection, kidney stones, bladder cancer, benign prostatic hyperplasia, glomerulonephritis, trauma to the urinary tract, renal cell carcinoma, prostatitis, urethral stricture, urethritis, exercise-induced hematuria, anticoagulanst side effect, coagulopathy, foreign body in the urinary tract, papillary necrosis, polycystic kidney disease, tuberculosis of the urinary tract, sickle cell disease, lupus, vasculitis, endometriosis affecting the urinary tract, menstrual contamination, pseudohematuria from food





PLAN:

Investigations:

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

- Urine: ‍urinalysis, ‍urine culture, ‍urine cytology

- CT pyeloscan

- Cystoscopy

Treatments:

- ‍Antibiotics if infection suspected

- Reassess medications that may contribute, such as anticoagulants and antiplatelets

- Increase fluid intake

Further care:

- Referral to urologist

- Referral to nephrologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop

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