Transcript Microscopic Haematuria - Derby GP Specialty Training Programme

Microscopic Haematuria
Transient Causes
• Transient
– UTI
– Exercise
• Spurious
– Menstrual contamination
– Sexual intercourse
Causes continued
Urological:
• BPH
• Bladder, kidney,
prostate, ureteric
cancer
• Renal stones
• Prostatitis
• Radiation cystitis
• TB
Renal
• IgA nephropathy
• Glomerulonephritis
• Vasculitis
When to Investigate
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Don’t opportunistically check urine
Only if clinical indication
Urine dip 1+ blood is positive
If symptomatic needs investigation
If asymptomatic- blood persistent on 2
out of 3 samples
Investigations
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BP
UE
ACR
If > 40 yrs – urology assessment, imaging
and cystoscopy
• If < 40 years and all normal- monitor
• If < 40 and any abnormality- renal rv
Monitoring
• Annual BP, UE and ACR
• Refer if visible haematuria or symptomatic
to urology
• Refer to renal if increasing proteinuria,
GFR < 30 or deteriorating GFR
Case
• 55 year old male
• Seen 2 weeks ago with fever, urine dip at the
time, negative for infection, 1+ blood
• Has brought 2 further samples over the last 2
weeks, both are 1+ of blood on dipstick
• Fever has resolved and he is now well in his
self
• You feel he needs referral to investigate
further
Summary
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Common
Diagnosed on dipstick
Check BP, UE, ACR
Under 40 think renal
Over 40 think urological