Haematuria

Ashley Southall

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 Overview
Objectives
Anatomy recap
Causes
History
Examination
Investigation
(Management)

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 Objectives
Recap on clinically relevant anatomy

To learn about causes, and investigation

of haematuria

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Anatomy

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 Anatomy
Which kidney sits higher?

Size of kidney on KUB?

Path of ureter on KUB x-ray?

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 Anatomy
Relations of the kidney?
Right – liver, adrenal, duodenum,
jejunum, colon
Left – adrenal, spleen, stomach,
pancreas, colon, jejunum
Both – diaphragm, psoas, quadratus
lumborum

Venous drainage of the testes?

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 Haematuria - Causes
Pre-renal
Renal
Ureters
Bladder
Prostate
Urethra
External

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 Pre-renal
Bleeding diathesis anticoagulant
other

Emboli AF
IE

Haemolysis Sickle cell

Malaria

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 Renal
Trauma Impact
Stones
March

Tumour
Glomerulonephritis
Polycystic disease
Infection pyelonephritis
TB

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 Ureteric
Calculus

Tumour

Schistosomiasis

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 Bladder
Tumour
Calculus
Infection
Radiation cystitis
Chronic interstitial cystitis
Radiation cystitis
Schistosomiasis
Catheter

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 Prostate
BPH
Carcinoma

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 Urethra
Urethritis
Calculus
Meatal ulcer

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 External to renal tract
Vaginal

Vulval / (penile) inflammation

PR

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 Other
Beetroot

Rifampicin

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 Commonest causes
UTI

Stones

BPH
TCC
Glomerulonephritis
Trauma

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 History
How often?
How heavy?
How long?

Where in stream? beginning

throughout

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 History
Painful or painless

Macro or microscopic

Other urinary symptoms

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 Urinary symptoms
Storage Voiding

Frequency Poor stream

Urgency Intermittent stream
Bladder pain Hesitancy
Stress incontinence Straining
Urge incontinence Incomplete emptying
Dribbling
Dysuria
Haematuria

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 History
Other symptoms

Fevers / rigors / sweats

Nausea / vomiting
Weight loss

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 History
Foreign travel

Smoking

Family history

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 Examination
Abdo

Prostate

External genitalia

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 Investigations
Urine dipstick
MC+S
cytology

Blood FBC / U+E

Imaging US renal tract

KUB x-ray

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 Investigations
Flexible cystoscopy

Further imaging IVU

CT ± contrast

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 Management

Treat the cause

May not find a cause - benign microscopic

haematuria

10% will go on to develop renal failure

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