Microscopic Hematuria

Age: ‍ years old

Gender: ‍malefemale



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, ‍diffuse, ‍dull, ‍mild

‍flank pain

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍hesitancy

‍nocturia

‍rectal bleeding, ‍oncetwice ‍, ‍bright reddark red, ‍withwithout clots

‍genital trauma

‍current menstrual period

‍vaginal bleeding

‍bleeding gum



Contributing factors:

‍smoking

‍exposure to certain chemicals

‍recent strenuous exercise

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

no use of: ‍anticoagulants, ‍aspirin, ‍cyclophosphamide

no family history of: ‍kidney disease





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:

‍Macroscopic hematuria ‍likelysuspectedpossible

DDx: urinary tract infection, kidney stones, bladder cancer, benign prostatic hyperplasia, prostatitis, glomerulonephritis, medication side effect (e.g., anticoagulants, nonsteroidal anti-inflammatory drugs), menstrual contamination, pseudohematuria, renal cell carcinoma, urethral stricture, urethritis, exercise-induced hematuria, lupus, sickle cell disease, tuberculosis of the urinary tract, foreign body in the urinary tract, trauma to the urinary tract, papillary necrosis, polycystic kidney disease, endometriosis affecting the urinary tract





PLAN:

Investigations:

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

- Urine: ‍urinalysis, ‍urine culture, ‍urine cytology

- Renal ultrasound

- CT pyeloscan

- Cystoscopy

Treatments:

- ‍Antibiotics if infection suspected

- ‍Analgesics if pain present

- Increase fluid intake

- Avoid NSAIDs

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