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Dark urine (hematuria)
First branch point
Microscopic
vs Gross
Gross hematuria is always pathologic (GN? Cancer? UTI? Prostate? Stone?)
First branch point
Microscopic
vs GrossGross hematuria is always pathologic (GN? Cancer? UTI? Prostate? Stone?)
Microscopic HematuriaFirst! always order urine culture (UC)
if UC pos
, treat and repeat UAPersistent hematuria despite antibiotics
Glomerular vs non-glomerular? (Check BP, BUN/Cr, proteinuria, RBC cast)
Nonglomerular microscopic hematuriaNormal BP, no AKI, no proteinuria, no RBC cast
☞CT urogram + cystoscopy if > 40yo (cancer is possible)
☞CT urogram +cystoscopy if < 40yo and Sx (dysuria, flank pain, abd pain, difficulty voiding)
☞ < 40 yo without symptom
annual monitor
Glomerular microscopic heamturia
New HTN AKI worsening proteinuria RBC cast☞ > 40 yo
Nephrology consult + Cystoscopy ☞ < 40 yo
Nephrology consult
Gross Hematuria -Recent period or Urologic procedure
MonitorPresence of blood clot?
Blood clot (probablyfrom lower urinary tract) Cystoscopy + UA
Blood clot UA
RBC pos or not?
UA < 3 RBC Myoglobinuria? Pigmenturia?
UA > 3 RBC Hematuria!(Glomerular? UTI? Cancer? Prostate?, Stone?)
-from glomerulus (proteinuria, RBC cast) → consult nephrologist
-Urine culture pos → Tx & repeat UA
-Urine culture neg →CT urogram and cystoscopy
UA < 3 RBC
Myoglobinuria? Pigmenturia?UA > 3 RBC
Hematuria!(Glomerular? UTI? Cancer? Prostate?, Stone?)-
from glomerulus (proteinuria, RBC cast) → consult nephrologist-Urine culture pos
→ Tx & repeat UA-Urine culture neg →CT urogram and cystoscopy
Cancer and Hematuria
Microscopic hematuria
→ bladder cancer in 3.7%, RCC in 1%, ureter cancer in 0.2%
→ cancer extremely rare in < 40yo
Microscopic hematuria → bladder cancer in 3.7%, RCC in 1%, ureter cancer in 0.2%
→ cancer extremely rare in < 40yo
Cancer and Hematuria (con'd)
Grosshematuria in older pt
→ >10% had malignancy, in some study > 25%!
→ 20-25% bladder cancer (painless, h/o
, male)
→ 1.3-10% prostate cancer
→ 0.6-2% RCC (flank pain, abd mass)
→ 21% stone (bladder, ureter, or renal)
→ 12-13% BPH (LUTS)
Grosshematuria in older pt→ >10% had malignancy, in some study > 25%!
→ 20-25% bladder cancer (painless, h/o
, male)→ 1.3-10% prostate cancer
→ 0.6-2% RCC (flank pain, abd mass)
→ 21% stone (bladder, ureter, or renal)
→ 12-13% BPH (LUTS)
Reference ☞ Symptom to Diagnosis An Evidence-Based Guide, 4th Edition, Chapter 21 "Hematuria" @adamcifu
Lastly, I am attaching "Dark Urine Schema" from "the Clinical Problem Solvers" @CPSolvers
Lastly, I am attaching "Dark Urine Schema" from "the Clinical Problem Solvers" @CPSolvers
Addendum
"PMID 12788998" on microscopic hematuria
☞The urine should be evaluated for bacteriuria and pyuria.
If either is present, a urine culture should be ordered
"PMID 12788998" on microscopic hematuria
☞The urine should be evaluated for bacteriuria and pyuria.
If either is present, a urine culture should be ordered
