Cause Of Hematuria Research Articles

Clinical Significance of Hematuria in Atrial Fibrillation With Oral Anticoagulation Therapy.

Hematuria is a common and important complication in atrial fibrillation (AF) patients on oral anticoagulation therapy (OAT). This study evaluated the clinical significance of hematuria and its relationship with genitourinary disease in AF patients receiving OAT.Methods and Results:Among 20,456 consecutive AF patients who visited a tertiary hospital from January 2005 to April 2015, 5,833 had hematuria. Of these 5,833 patients, 3,798 were on OAT (OAT(+) group) and 2,035 were not (OAT(-) group). A total of 1,785 patients from each group were then matched on propensity score analysis. The prevalence of cancer and other diseases in the genitourinary tract was evaluated. While there was no difference in the prevalence of genitourinary stones or urinary tract infection, genitourinary cancer was significantly more common in the OAT(+) group than in the OAT(-) group (1.6% vs. 0.7%, P=0.011). Bladder cancer was the most common genitourinary malignancy, and it was significantly more common in the OAT(+) group (1.2% vs. 0.5%, P=0.019). Subjects on warfarin were more likely to have bladder cancers of lower pathologic grade (63.6% vs. 33.3%, P=0.124). OAT was associated with a higher prevalence and early detection of genitourinary cancer in AF patients with hematuria. Meticulous evaluation of the cause of hematuria is necessary in AF patients with hematuria receiving OAT.

Microhematuria at Point of Care

The case of a 35-year-old man presenting microscopic hematuria allows the following topics to be examined in depth: 1. How is hematuria defined and classified? 2. What are the causes of hematuria? 3. Hematuria is an important sign for the diagnosis of cancer of the urinary system. What are the risk factors for bladder carcinoma? 4. What is the role of the urinary dipstick test in the diagnosis of hematuria? 5. What is the role of the examination of urine sediment in the diagnosis of hematuria? 6. Once microscopic hematuria is confirmed, how can we proceed to reach a final diagnosis?

Haematuria

Haematuria is the presence of red blood cells in the urine, it is classified into two types: visible and non-visible. Non-visible haematuria is considered significant if blood is detected in two-out-of-three urine samples taken 2 to 3 weeks apart. Common causes of haematuria in adults include urinary tract infection, exercise-induced haematuria, nephrological disease, bladder cancer and renal stones. Common causes of haematuria in children include hypercalciuria, IgA nephropathy and post-streptococcal glomerulonephritis. Patients with visible haematuria should be referred for investigation to exclude urological cancer. Patients with non-visible haematuria should have their blood pressure, urinary albumin-to-creatinine ratio and estimated glomerular filtration rate measured, to determine if they require onward referral to secondary care. The new National Institute for Health and Care Excellence guidelines for recognition and referral of suspected cancer identify those patients with haematuria that should be referred through the 2-week wait pathway.

Anterior Nutcracker syndrome as a rare cause of hematuria in an 8 year old boy: A case report

Nutcracker syndrome is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery. It results in left renal venous hypertension, and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein. We report a rare case in an 8-year-old boy who presented with a history of intermittent episodes of hematuria leading to anemia and left flank pain. Ultrasound examination of abdomen revealed bulky left kidney and features of subacute medical renal disease. Computed tomography of abdomen showed compressed left renal vein between aorta and superior mesenteric artery. Authors report the successful operative management of this rare syndrome in a pediatric patient.

Proteinuria and hematuria in the neonate.

Neonatal proteinuria and hematuria while not common can have potentially devastating consequences if left undiagnosed and untreated. It is important to distinguish between inherited and acquired causes of proteinuria to initiate appropriate and timely treatment. With regards to hematuria, it is critical to identify true hematuria from pseudo-hematuria to balance between thorough investigation and unnecessary laboratory work up. This review provides an overview of the common causes of hematuria and proteinuria in a neonate. The identification of genetic mutations in nephrotic syndrome has improved our understanding of the role of various proteins that play an important role in maintaining the glomerular filtration barrier. With the advancement in our ability to provide care for extreme premature neonates, the incidence of acute kidney injury has increased in these neonates along with proteinuria and hematuria. Persistent proteinuria after neonatal acute kidney injury would be of interest in regards to the risk of developing future chronic kidney disease and hypertension.

Nutcracker Syndrome in Children Presenting With Recurrent Gross Hematuria

Nutcracker syndrome is a rare cause of hematuria. Two children who presented to us with recurrent gross hematuria were evaluated. Renal parenchymal disease and abnormalities in the urinary tract were ruled out. CT angiography revealed a compressed left renal vein with dilatation and hence a diagnosis of nutcracker syndrome was made. A high index of suspicion is required for diagnosis of nutcracker syndrome.

An Unusual Condition Simulating Malignancy: A Patient with Fibroepithelial Polyp of the Renal Pelvis Covered by the Blood Clot

Fibroepithelial polyp of the renal pelvis is a rare cause of hematuria, and is frequently mistaken for transitional cell carcinoma. We report a 78-year-old female presented with intermittent painless gross hematuria initially suggestive of transitional cell carcinoma. CTU showed high density shadow in the right renal pelvis and proximal ureteral lumen. IVU and retrograde urograph showed a filling defect in the right renal pelvis and proximal ureter that was found to be a fibroepithelial polyp of the renal pelvis. This case demonstrates a rare cause of gross hematuria that should be considered when the imaging findings and presentation are atypical for more common etiologies of hematuria.

Frequency and clinical significance of urinary schistosomiasis in haemophilia

Abstract Haematuria is not uncommon in people with haemophilia and is mainly caused by spontaneous haemorrhage or trauma. The frequency and clinical significance of urinary schistosomiasis in the aetiology of haematuria among haemophiliacs in schistosomiasis endemic countries such as Nigeria have not been previously studied. We retrospectively analysed the clinical and laboratory data of 45 haemophiliacs with haematuria in Nigeria with the aim of determining the frequency of urinary schistosomiasis and other causes of haematuria among haemophiliacs, the haematological profiles of haemophiliacs with haematuria and the severity of schistosomal haematuria relative to non-schistosomal haematuria. Haematuria was due to spontaneous haemorrhage in 23 (51.1%) patients, trauma in 14 (31.1%) patients and schistosomiasis in 8 (17.8%) patients. There were no significant differences in mean values of haematological parameters between patients with spontaneous and traumatic haematuria. However, compared to patients with spontaneous and traumatic haematuria, patients with schistosomal haematuria had significantly lower mean Hb concentration (8.5 vs.11 and 11.5g/dL; p<0.05) and significantly higher mean eosinophil count (0.42 vs. 0.21 and 0.2×109/L; p<0.05). This study revealed that schistosomiasis was responsible for 17.8% of cases of haematuria in northern Nigerian haemophiliacs. Schistosomal haematuria was severe and caused significant anaemia in contradistinction to spontaneous and traumatic haematuria that were mild and did not cause significant anaemia. A superimposed pro-haemorrhagic host-parasite relationship was responsible for the severe haematuria seen in haemophiliacs with schistosomiasis, a situation that would potential increase their risk of iron deficiency and its attendant consequences including childhood cognitive impairment. Haemophiliacs with haematuria in schistosomiasis endemic countries should be investigated by urinalysis for early detection and treatment. Haemophiliacs who present with haematuria in association with eosinophilia should evoke the strongest clinical suspicion for schistosomiasis. Parents of haemophiliacs should be counseled on how to protect their children from exposures to infected waters.

Abstract 13392: Clinical Significance of Hematuria in Patients With Atrial Fibrillation Receiving Oral Anticoagulation Therapy

Introduction: The presence of hematuria is frequently related with underlying genitourinary pathologies such as urolithiasis or malignancies. Although hematuria is an important and common complication in atrial fibrillation (AF) patients taking oral anticoagulation therapy (OAT), its clinical implication is not fully elucidated. Objectives: We evaluated the clinical significance of hematuria and its relationship with genitourinary disease in patients with AF. Methods: This study included 18,086 consecutive AF patients with (OAT+, n=11,432) or without OAT (OAT-, n=6,654) who visited to a tertiary Hospital from January 2005 to April 2015. The degree of urinary red blood cells (RBC) was reported to range from 0 to 3+ on random urinalyses. The incidence of cancer or stone in the genitourinary tract (kidney, ureter, and bladder) was evaluated. All data were obtained from the Clinical Data Repository System. Results: Overall, 144 (0.8%) patients had malignancies and 164 (0.9%) patients had stones in the genitourinary tract. Hematuria was observed in 3,737 (32.7%) and 2,017 (30.3%) in patients with and without OAT (p=0.001), and the large (≥ urine RBC 3+) hematuria was observed in 1,382 (12.1%) and 666 (10.0%) patients with and without OAT, respectively (p<0.001). While 39 (2.8%) OAT+ patient with large hematuria had malignancies, 8 (1.2%) OAT- patient had (p=0.026). However, if the patients had small hematuria (urine RBC 1+ or 2+), the incidence of genitourinary cancer was not different between OAT+ and OAT- groups (p=0.266). The incidence of genitourinary tract stone in patients with large or small hematuria was comparable between OAT+ and OAT- groups. Conclusions: Large hematuria was associated with higher incidence of cancer in the genitourinary tract in OAT+ group, but not in OAT- group. A meticulous evaluation of the cause of hematuria is needed, if AF patients receiving OAT had large hematuria.

Urothelial Carcinoma in Pediatric Patient.

Transitional cell carcinoma as a cause of hematuria is a rare entity in the pediatric age group. An 11-year-old child presented with gross, painless hematuria. Ultrasonogram and computed tomography scan of the child revealed a tumor in the posterolateral wall of the bladder. Cystoscopically, the mass was present in the bladder away from the trigone area about 2cm lateral to the right ureteric orifice. Transurethrally, the tumor was excised by a cystoscope. Histopathologically, it was a low-grade noninvasive urothelial carcinoma of the bladder. A follow-up cystoscopy at 6months and 1year had no recurrence. Literature review revealed the pediatric age group as an uncommon age for urothelial carcinoma of bladder, which has a different biological behavior of being low malignant potential compared to their adult counterpart. They have been treated with transurethral resection of bladder tumor without any adjuvant therapy. There is no definite follow-up schedule for these tumors as it occurs in very small number of cases.

Discussion of Relationship between Hematuria and Ultrasonic Renal Calculi in Young Man After Exercise

<strong>Objective: </strong>To discuss the relationship between hematuria and ultrasonic renal calculi in young man after exercise. <strong>Method:</strong> In the medical observation, 48 cases of young male patients with hematuria after exercise in our hospital from January 2011 to December 2012 were selected as the observation objects, the subjects were transient hematuria, and 92 patients without hematuria were selected as the contrast, all patients underwent ultrasound examination, the detection rate of renal calculi and the ultrasonic manifestation were retrospectively analyzed. <strong>Results: </strong>The incidence of renal calculi of the young and middle-aged male patients with hematuria after exercise is statistically different in different parts and different age (<em>p</em> < 0.05), and the incidence rate of renal calculi in patients with hematuria after exercise and patients without hematuria was significantly different (<em>p</em> < 0.05), as shown in Table 1, Table 2. There was no obvious linear relationship between the degree of hematuria and the incidence of renal calculi after young men's exercise, as shown in Table 3. <strong>Conclusion: </strong>From this clinical research results we can know that renal calculi is the main cause of hematuria after exercise for the young man, and the clinical examination and diagnosis of renal calculi with ultrasonography has higher clinical detection rate, therefore the clinical application value is higher.

RECURRENT PERI-OP HAEMATURIA IN REPEAT LOWER SEGMENT CAESAREAN SECTION: an unusual Presentation of Renal Cell Carcinoma in Pregnancy (A Case report with Literature Review)

Background: Trauma to urinary bladder is the commonest cause of haematuria in repeat lower segment caesarean section. However, recurrent post op haematuria draws the attention to other aetiologies. Case: A 27 year old lady, G2P1L1, post caesarean pregnancy at term gestation, underwent elective caesarean section and tubectomy. She developed haematuria in perioperative period in episodic manner. Abdominal and pelvic ultrasound revealed a solid mass lesion in the upper pole of right kidney of size 5.8x4.6mm, which was confirmed by CECT of abdomen to be renal cell carcinoma. She was managed with radical nephrectomy in the urology centre without any adverse event. This rare presentation of the case and its successful management, prompted us to present this case with available literatures review.

Treatment of nutcracker syndrome with open and endovascular interventions.

Nutcracker syndrome (NS) is a rare cause of hematuria, flank pain, and renal venous hypertension due to compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery. To evaluate outcomes of open surgery and endovascular interventions, we reviewed our experience. A retrospective review of clinical data of all patients treated at our institution with an intervention for NS between January 1, 1994, and February 28, 2014, was performed. Primary outcomes were morbidity and mortality. Secondary outcomes included late complications, patency, freedom from reintervention, and resolution of symptoms. Thirty-seven patients (30 female, seven male) with a mean age of 27 years (range, 14-62 years) were treated. The most frequent symptom was flank pain (97%); the most frequent sign was hematuria (68%). NS was diagnosed with duplex ultrasound scanning with measurement of LRV diameters and flow velocities (87%), with computed tomography or magnetic resonance venography (94%), and with contrast venography with measurement of pressure gradients (93%). Initial treatment was open surgery in 36 patients, endovascular in 1. Distal transposition of the LRV into the inferior vena cava (IVC) was performed in 31 patients. Adjunctive procedures to optimize venous outflow included great saphenous vein cuff in six patients, great saphenous vein patch in four, and both cuff and patch in four. Three patients had patch alone; two had transposition of the left gonadal vein into the IVC. Two patients had anterior reimplantation of retroaortic LRV into the IVC. There were no major early complications, renal failure, or mortality. Three patients underwent early reinterventions within 30 days (stent, two; open revision, one). All LRVs and left gonadal veins were patent at discharge. Follow-up was 36.8 ± 52.6 months (range, 1-216 months). Reinterventions after 30 days were performed in eight patients because of LRV stenosis (n = 7) or LRV occlusion (n = 1). One stent migrated into the IVC and required endovascular removal with repeated stenting. Six patients required stenting. Primary, primary assisted, and secondary patencies at 24 months were 74%, 97%, and 100%, respectively. Freedom from reintervention at 12 and 24 months was 76% and 68%, respectively. Resolution of symptoms occurred in 33 patients (87%). Open surgery, mostly LRV transposition, remains a safe and effective treatment of patients with NS. However, one of three patients after open repair required reintervention, most frequently LRV stenting. Open reconstruction should be tailored to the patient's anatomy, and placement of vein cuff or patch may reduce restenosis. Although renal vein stents improved patency, the safety and durability of currently available stents need to be established.

Protocolo diagnóstico de la microhematuria

Hematuria is defined as the presence of blood in urine. It is a clinical sign appearing in many urological and renal diseases. Hematuria is classified as macroscopic or microscopic, according to the appearance of urine and glomerular or non-glomerular depending on blood origin. The conclusive diagnosis of hematuria is established by analysis of urinary sediment, and the finding of hematuria makes necessary patient's referral for urological or nephrological studies. In this protocol, the most important causes of hematuria and the diagnostic work-up for patients with this problem are reviewed.

Hematuria with bladder tamponade and renal failure due to gallbladder cancer metastasis

s / Urological Science 26 (2015) S50eS81 S72 carried at least one C allele at rs187238 had a 2.760efold risk of UCC. However, the rs1946518 and rs187238 polymorphisms of the IL-18 gene did not affect tumor stage among the UCC patients. Conclusion: The rs187238 polymorphic genotypes of IL-18 might contribute to the susceptibility of UCC and the synergic effect of smoking was also demonstrated. NDP086: HEMATURIA WITH BLADDER TAMPONADE AND RENAL FAILURE DUE TO GALLBLADDER CANCER METASTASIS Ching-Ming Su, Chien-Yuan Wang, Hsiu-Nan Tsai, Wei-Che Weng. Department of Urology, Kaohsiung Municiple United Hospital, Taiwan Introduction: There are many possible causes of hematuria including: urinary tract infection, urolithiasis, tumor in kidney or bladder, exercise, drug, bleeding disorder or trauma. Herein we report a case of hematuria with bladder tamponade due to gallbladder cancer metastasis Case report: A 61-year-old women presented with gross hematuria, nausea, vomiting to our ER for help. According to the statement of her, DM, CRI, gallbladder stone, cancer post operation. Sonography revealed bladder tamponade and left hydronephrosis. Due to poor condition, CT scan was performed and revealed much bladder clot, left hydronephrosis, ascites and favored carcinomatosis. Emergent cystoscopy removed blood and bladder tumor was noted. TURBT was performed and pathology revealed gallbladder cancer metastasis NDP087: PROGNOSTIC VALUE OF VISFATIN PROTEIN OVEREXPRESSION IN UPPER TRACT UROTHELIAL CARCINOMAS IN TAIWAN Hung-Lung Ke , Hui-Hui Lin , Wei-Ming Li , Ching-Chia Li , Lin-Li Chang , Yi-Chen Lee , Chun-Nung Huang , WenJeng Wu . Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Anatomy, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Microbiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal HsiaoKang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 8 Pingtung Hospital, Department of Health, Executive Yuan, Pingtung, Taiwan Purpose: Visfatin, a newly discovered adipocytokine, is a pro-inflammatory cytokine. This study aimed to evaluate the predictive value of visfatin on prognosis of patients with upper tract urothelial carcinoma. Materials andMethods: One-hundred and five patients (median age1⁄4 64, range 1⁄4 24-84 years) were included in this study. Visfatin expression in upper tract urothelial carcinoma tissues was analyzed by immunohistochemistry. Visfatin expression was correlated with clinicopathologic variables using the c2 test. The prognostic value of visfatin for recurrence-free and cance-specific survival was evaluated by Kaplan-Meier estimates, and the significance of differences between curves was evaluated by the logrank test. Cox regression model was also used to evaluate the hazard ratios of visfatin on survival. Results: High visfatin expression in upper tract urothelial carcinoma tissues was significantly correlated with tumor stage (p 1⁄4 0.001), grade (p 1⁄4 0.007) and p53 expression (p 1⁄4 0.07). High visfatin expression was associated with poor recurrence-free and cancer-specific survival. Cox regression analysis also revealed that visfatin is an independent predictor of recurrence-free (HR 1⁄4 3.22, p 1⁄4 0.009) and cancer-specific survival (HR 1⁄4 5.74, p 1⁄4 0.023). Conclusion: Our findings indicated that higher visfatin expression is a potential biomarker to predict patient survival. Further study is necessary to investigate the molecular mechanisms of visfatin involved in the cancerous processes of upper tract urothelial carcinoma. NDP088: SIGNAL TRANSDUCERS AND ACTIVATORS OF TRANSCRIPTION 3 (STAT3) EXPRESSION AND THE PROGNOSIS IN UPPER URINARY TRACT UROTHELIAL CARCINOMA Hung-Lung Ke , Szu-Han Chen , Hui-Hui Lin , Wei-Ming Li , Ching-Chia Li , Hsin-Chih Yeh , Chun-Nung Huang , Wen-Jeng Wu. Graduate Institute of Medicine, Kaohsiung, Taiwan; Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 6 Pingtung Hospital, Department of Health, Executive Yuan,

A rare cause of hematuria and abdominal pain: our clinical experiences with Nutcracker Syndrome

Compression of the left renal vein between the abdominal aorta and the superior mesenteric artery is named as Nutcracker syndrome (NCS). It is an extremely rare pathology which usually manifests with hematuria, pain, or proteinuria. The diagnosis of the disease is primarily based on clinical suspicion. Various treatment models such as observation, conservative therapies, and surgery are available. In this article, we discuss a rare condition of NCS in three patients with left renal vein compression in the light of radiological findings.

Multi-Detector Row Computed Tomography Urography (MDCTU) in the Evaluation of Microscopic Hematuria in Adults

Multi-detector row computed tomography urography (MDCTU) becomes the imaging modality of choice for evaluation of the kidneys and urinary tract. The aim of this study was to discuss and illustrate the role of MDCTU, on a 32-row CT scanner in the evaluation a variety of entities that were frequently associated with microscopic hematuria in adults. This prospective cohort study was performed in the period of August 2013 to October 2014. Fifty positive participants to microscopic hematuria were examined at the radiology department of Alnilin Diagnostic Medical Center and Antalya Medical Center. Computed tomography urography (CTU) scanning was performed using two powerful performances, high speed multi-detector row on 32-row CT scanners (Siemens Healthcare Global, Somatom Emotion Duo Eco). Statistical analysis was done through the standard Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 15 for windows. MDCTU established the correct cause of microscopic hematuria in (44; 88%) of participants. In (6; 12%) of participants, no cause of hematuria was identified based on the standard of references. The causes of hematuria in (41; 82%) participants were diseases in the upper urinary tract, while urinary bladder neoplasms (2; 4%) and diverticulum (1; 2%) were the causes of hematuria (3; 6%) in the lower urinary tract. Thirty two-row MDCTU scanner demonstrated satisfactory results in the investigation of microscopic hematuria, being able to demonstrate a wide spectrum of diseases affecting the urinary tract is the main advantage of the technique.

Haematuria in Postrenal Transplant Patients

Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team.

A Differential Diagnosis of Haematuria following a Motor Vehicle Collision: Nutcracker Syndrome.

A young female presented to the emergency department following a motor vehicle collision. She complained of left flank pain and was found to have haematuria. After investigation no trauma related injuries were identified. However, an incidental finding of nutcracker phenomenon/syndrome was made. Nutcracker phenomenon is a rare cause of haematuria resulting from nontraumatic compression of the left renal vein between the superior mesenteric artery and the aorta. It affects females more than males and its presentation can range from asymptomatic to debilitating haematuria, pelvic congestion in females, varicosities in males, and pain. No validated diagnostic criteria exist and treatment is usually surgical in those with debilitating symptoms or refractory anaemia.

Haematuria: classification, causes and investigations.

The majority of patients who attend haematuria clinics for investigation of blood in their urine will be found to have either no cause or a benign cause. Between 20% and 25% of people with visible blood in their urine and 5-10% of people with non-visible blood in their urine will be diagnosed with a urological malignancy, i.e. bladder, kidney or prostate cancer. Haematuria is therefore a significant symptom that should be investigated promptly and thoroughly to exclude cancer as quickly as possible. This article gives an overview of the causes of haematuria and the investigations that patients will undergo when referred to a haematuria clinic.