Saturday, November 21, 2009

History taking in a case of hematuria

First of all, the causes of hematuria :




1) Kidney

Glomerular diseases
Polycystic kidney disease
Kidney stones
Trauma (renal biopsy)
Renal adenocarcinoma
Renal TB
Renal vein thrombosis
Embolism

2) Ureter

Ureteric stones
Neoplasm

3) Bladder

Bladder stones
CA bladder
Bladder Trauma
Inflammation (Cystitis, stones, TB)

4) Prostate

Benign Prostatic Hyperplasia
CA prostate

5) Urethra

Urethral trauma
Urethral stones
Neoplasm
Trauma

General causes

Anticoagulants (Warfarin)
Thrombocytopoenia
Sickle cell disease
Malaria
Schistosomiasis
Blood dyscarias (Hemophilia) 
Sternous exercises

Red urine

Hemoglobinuria
Myoglobinuria
Beetroot
Senna
Rifampicin
Phenopthalein
 
History : Important questions!

1) Is there any pain on micturition?
2) Is it :

Painless hematuria? (Renal TB, RCC, CA bladder)
Total hematuria? (suggestive of bleeding from upper urinary tract)
Initial hematuria? (bleeding from lower urinary tract = prostate?urethra?)
Terminal hematuria? (bleeding from prostate?bladder?)

3) Is there family history of renal disease? (Polycystic)
4) Is there any h/o of drug intake? (anticoagulant)
5) Is there any h/o of substance ingestion that might cause red discolouration of urine?
6) Is there travel history? (Malaria/Schistosomiasis)
7) Is there any fixed loin pain? (Renal causes)
8) Is there any colicky loin to groin pain? (Ureteric colic)
9) Any symptoms suggestive of bladder stones? (Frequency, suprapubic pain, etc)
10) Any symptoms of prostatism?
11) Any h/o of trauma? (including renal biopsy)
12) Any h/o of general debility? (malaise, lost of weight, appetite, etc)
13) Any h/o of bleeding disorders?
14) Any h/o of TB in other parts of body? (esp. pulmonary)
15) Any h/o of sternous exercises done recently?
16) Any h/o of dehydration?

Investigations

1) Full blood count
2) ESR
3) Urine microscopy
4) Chest X-ray
5) Coagulation profile (PT and INR)
6) KUB film or IVU (calculus)

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