Cause Of Hematuria Research Articles

Migrated Jewett nail: an unusual cause of hematuria

Migrated Jewett nail: an unusual cause of hematuria

Comparison of red blood cell volume distribution curves and phase-contrast microscopy in localization of the origin of hematuria

Objectives To determine the ability, reliability, and accuracy of urinary red blood cell volume distribution curves obtained with the use of an autoanalyzer to identify the origin of isolated microscopic hematuria and compare the results with those obtained with phase-contrast microscopy (PCM). Methods A prospective evaluation was performed in 45 patients with glomerular or nonglomerular microhematuria detected by urinalysis, PCM, radiologic evaluation, endoscopy, and, sometimes, renal biopsy. Urine samples were analyzed in an electronic particle-size analyzer, and the tests were repeated to assess reliability. The kappa correlation coefficient was used to assess reliability and to compare the results with the final diagnosis and with those obtained with PCM. Results Of the 28 patients who had a single definite cause of hematuria, 16 had glomerular bleeding and 12 nonglomerular bleeding. The origin of hematuria was correctly identified by the autoanalyzer in 60.7% of cases. A statistically significant correlation was found with the final diagnosis (kappa = 0.433, P = 0.048). The reliability was excellent (kappa = 0.917, P <0.0001). Of 16 patients with glomerulonephritis, 10 (62.5%) were correctly identified by PCM and 14 (87.5%) by the autoanalyzer. In 12 patients with nonglomerular bleeding, PCM was accurate in 7 (58%) and the autoanalyzer in 3 (25%). The results were statistically correlated with the findings of PCM (kappa = 0.327, P <0.00001). Conclusions The use of an autoanalyzer is easy, reproducible, and noninvasive. It provides reliable information to orient the diagnosis toward glomerular or nonglomerular bleeding. It is as accurate as PCM for screening for the source of hematuria.

Comparison of Excretory Phase, Helical Computed Tomography with Intravenous Urography in Patients with Painless Haematuria

AIM: To compare excretory phase, helical computed tomography (CT) with intravenous (IV) urography for evaluation of the urinary tract in patients with painless haematuria. MATERIALS AND METHODS: Ninety-one out-patients had IV urography followed by helical CT limited to the urinary tract. Both IV urograms and CT images were evaluated for abnormalities of the urinary tract in a blinded, prospective manner. The clinical significance of abnormalities was scored subjectively and receiver operator characteristic curve analysis was performed. RESULTS: In 69 of 91 patients (76%), no cause of haematuria was identified. In 22 of 91 patients (24%), the cause of haematuria was identified as follows: transitional cell cancer of the bladder ( n=15), urinary tract stones ( n=3), cystitis ( n=2), haemorrhagic pyelitis ( n=1) and benign ureteral stricture ( n=1). With IV urography, there were 15 true-positive, seven false-negative and three false-positive interpretations. With CT, there were 18 true-positive, four false-negative and two false-positive interpretations. There was no significant difference between IV and CT urography for the significance of the positive interpretations ( n=0.47). CONCLUSION: Excretory phase CT urography was comparable with IV urography for evaluation of the urinary tract in patients with painless haematuria. However, the study population did not include any upper tract cancers. O'Malley M. E. et al. (2003). Clinical Radiology 58, 294–300.

Microhematuria after renal transplantation in children.

The renal transplant (Tx) recipient is at risk for developing various complications including urolithiasis, the only manifestation of which may be hematuria. However, there are no data on the prevalence of microscopic hematuria in renal Tx recipients. The objective of our study was to determine the prevalence of microhematuria in our pediatric Tx patients and to investigate the causes of microhematuria. Records of all pediatric renal Tx recipients followed at our center from September 1999 to September 2000 were retrospectively reviewed; of the 21 patients, seven (33%) had persistent microscopic hematuria that was first noted 2.9 years post-Tx. Patients with and without hematuria had similar baseline characteristics. Only one patient had pre-existing hematuria that continued post-Tx. The etiology of hematuria in the other six patients was: recurrent IgA nephropathy (one patient), CMV nephritis (one patient), and unexplained (four patients). None had renal calculi or hypercalciuria. Three of the four patients with unexplained hematuria have chronic allograft nephropathy, and the fourth (original disease dysplasia) has hypocomplementemia. At their last follow-up, 5.3 years after onset of hematuria, all patients are alive with stable allograft function. In conclusion, microscopic hematuria is not uncommon in pediatric renal Tx recipients. While causes of post-Tx hematuria are diverse, stones are not commonly seen. Whether chronic allograft nephropathy per se can be implicated as a cause of hematuria remains to be determined. Renal biopsies should be considered at the onset of hematuria if proteinuria and/or deterioration in renal function are seen concomitantly, to look for recurrent or de novo glomerulonephritis.

Hematuria: an algorithmic approach to finding the cause.

Many conditions can cause hematuria, but the differential diagnosis can be simplified with a systematic approach. We discuss the common causes of hematuria and how to evaluate it.

16-Year-Old Boy With Gross Hematuria

16-Year-Old Boy With Gross Hematuria

HEMATURIA IN CHILDREN

Children with hematuria require a thorough history and physical examination. Not all children with hematuria require the same investigations. The only laboratory test uniformly required for children with the various presentations of hematuria is a complete urinalysis with a microscopic examination. The rest of the evaluation is tailored according to the pertinent history, physical examination, and other abnormalities on the urinalysis. This article has provided a brief summary of the more common causes of pediatric hematuria and suggestions for tailoring the patient's evaluation according to the presentation. Most causes of hematuria in pediatrics represent medical conditions that often require referral to a pediatric nephrologist. Indications for referral to a urologist are more limited and include stones that do not pass spontaneously or are more than 5 mm in diameter, renal injury from trauma, anatomic abnormalities, or gross hematuria that seems to originate from the urinary tract and is without an identified cause.

Benign familial hematuria associated with a novel COL4A4 mutation

We describe a father and three offspring with hematuria. The father and one girl also complained of flank pain. Renal function tests and ophthalmological examinations were normal in all. The father had very mild neural deafness. The renal biopsy samples of two affected siblings showed changes compatible with thin basement membrane disease. Genetic analysis revealed a novel missense mutation in exon 32 of COL4A4 to be responsible for the phenotype in this family. We suggest that thin basement membrane disease may have overlapping clinical features with other causes of hematuria; genetic analysis may help in the differential diagnosis and help us further understand the disease processes.

Haematuria; a late complication of TURP?

This study was designed to investigate the cause of haematuria for patients that had previously undergone a TURP. One hundred patients were identified in a walk-in haematuria clinic as having been treated by TURP and were prospectively investigated for the cause of bleeding. Prostate regrowth was the diagnosis in 63% of cases. A diagnosis of malignancy was made for 23.5% of these patients. We have confirmed the hypothesis that for patients who present with haematuria after a TURP, the prostate is the usual source of bleeding.Prostate Cancer and Prostatic Diseases (2001) 4, 178-179.

Haematuria in Africa: is the pattern changing?

To study the aetiological factors and clinical presentation of haematuria as seen in a tertiary healthcare centre in a developing country in Africa. The study comprised a retrospective review of the diagnostic indices and notes of patients with macroscopic haematuria presenting at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 7-year period from 1985 to 1991. Of a total of 2726 urology patients and 11 232 surgical patients, 482 had haematuria (17.7% and 4.3%, respectively, 387 males and 95 females, ratio 4.1 : 1, mean age 44.8 years, range 6-80). Many presented late with advanced malignant disease (T3, T4). Investigations useful in the diagnosis were urinary cytology, intravenous urography and cysto-urethroscopy. Common causes of haematuria were bladder carcinoma in 142 (31%), benign prostatic hypertrophy in 64 (14%) and urinary stones in 54 (12%). Recurrent haematuria in patients over 30 years of age in this environment should be considered or deemed to be caused by malignancy until confirmed otherwise. An educational programme is required to alert the population to the significance of haematuria as a symptom demanding a thorough investigation before treatment. This would need support by a haematuria service for accelerated diagnosis and treatment.

Asymptomatic Urinary Abnormalities

Urinalysis is the most convenient and important diagnostic tool for the kidney diseases. Abnormal urinary findings provide powerful information for the diagnosis of a kidney disease. There are several common urinary abnormalities without subjective symptoms : hematuria, proteinuria, and asymptomatic bacteriuria. There are many causes of hematuria : glomerulonephritis, interstitial nephritis, vascular diseases, cystic kidney disease, renal calculi, coagulation disorders, urinary tract infection, trauma, and tumors. It is essential to clarify the origin of hematuria by the use of diagnostic flow sheets. Despite all the diagnostic approaches, however, unexplained hematuria is found in 10~15% of subjects with hematuria. Periodic follow-up is recommended per 3 to 6 months for at least three years for them. The proteinuria of the glomerular origin is important for the progression of the renal diseases. We have to differentiate the proteinuria according to its origin and underlying systemic diseases including diabetes mellitus and hypertension. We also recommend a kidney biopsy for nephrotic range proteinuria for the diagnosis, treatment, and prognosis of the disease. Asymptomatic bacteriuria is define as a bacterial colony count above 105/ml in two consecutive urine cultures. Management is generally not recommended for the asymptomatic bacteriuria in elderly patients but recommended in pregnant women and diabetes mellitus patients. From our point of view, subjects showing urinary abnormalities, such as hematuria, proteinuria, and bacteriuria, must be kept under close surveillance.

Polycystic Kidney Disease In Pregnancy In A Nigerian Woman

Adult Polycystic Kidney disease (ADPKD) is a known but uncommon cause of haematuria in pregnancy in this environment. Other causes include, haemaglobinopathies, calculi, pyelonephritis, schistosomiasis, haemangiomata and neoplasms. Although ADPKD is the commonest single gene disorder of man affecting both sexes, it usually presents in adulthood. It often presents in pregnancy with features of renal impairment, with or without haematuria. We present this case of ADKPD with life-threatening haematuria, acute renal failure, spontaneous abortion and recovery following nephrostomy tube insertion. (Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 40-42)

Haematuria: A Long-Term Problem after Prostatectomy

Objective: The causes of ‘late’ haematuria (2 years or more) following endoscopic and open prostatectomy were studied. Methods: Between 1994 and 1996, more than 400 patients were evaluated for haematuria. Ninety patients with post-prostatectomy haematuria were investigated with upper tract imaging and cystoscopic examination. Amongst these 90 patients, 30 presented with haematuria within 2 years of surgery. These patients were excluded from the study as they had normal investigations. Results: Of these 60 patients, 24 (43%) had demonstrable causes of haematuria in their urinary tract. Six of them had urinary tract malignancy. Conclusions: There is a substantial likelihood of finding a cause for haematuria in patients who had prostatectomy even though they had full-scale urological investigations before. There is a need, therefore, to carry out necessary screening investigations in such patients.

Urinary Cytologic Findings in Patients With Benign and Malignant Adenomatous Polyps of the Prostatic Urethra

Abstract Context.—Urethral adenomatous polyps with prostatic epithelium (also known as benign prostatic epithelial polyps [BPEPs]) are a documented cause of hematuria, dysuria, and hematospermia, conditions that may prompt cytologic evaluation of urine. Design.—The urine cytologic test findings in 5 cases of biopsy-proven BPEPs and in 1 case of prostatic ductal adenocarcinoma (PDA) that presented as a urethral polyp were retrospectively evaluated. Immunocytochemical stain for prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and high-molecular-weight cytokeratin (34βE12) were used in evaluation of the lesions. Results.—In 4 of 5 cases of BPEPs, clusters of bland columnar cells with uniform, oval nuclei were seen. Positive immunostaining for PSA and PAP confirmed the prostatic origin of the clusters in 2 cases. One urine sample contained abundant goblet cells and extracellular mucin, consistent with intestinal metaplasia coexisting in the bladder biopsy specimen. The urine sample in the fi...

Screening of Tanzanian women of childbearing age for urinary schistosomiasis: validity of urine reagent strip readings and self-reported symptoms.

The screening of women of childbearing age for haematuria, leukocyturia and proteinuria to detect urinary schistosomiasis can be confounded by several factors such as menstruation, pregnancy and genitourinary infections. We therefore undertook a study in an area endemic for Schistosoma haematobium in the United Republic of Tanzania to carry out the following: assess the sensitivity, specificity and predictive values--in women of childbearing age--of indirect indicators of urinary schistosomiasis, as measured by urine reagent strip readings; assess the predictive values of self-reported symptoms; and finally to estimate the morbidity attributable to S. haematobium. A total of 303 women (128 and 175, respectively, living in high- and low-risk sites) participated in the study. Haematuria was more frequent among women excreting S. haematobium eggs than among those who did not (65% versus 32%). The predictive potential of all indirect disease markers was poor in the highly endemic site, while in the sites with low endemicity the negative predictive values were high. Among infected women, 54% of haematuria could be attributed to S. haematobium, but for patients with more than 10 eggs/10 ml the attributable fraction rose to 70%. Symptoms of "bloody urine" and "pain while urinating" were recalled significantly more often by women living in the highly endemic site. On a population level, one-third of the self-reported cases with bloody urine could be attributed to urinary schistosomiasis. Screening of women of childbearing age for urinary schistosomiasis using urine reagent strips can be biased in two directions. The prevalence of S. haematobium will be overestimated if other causes of haematuria, such as reproductive tract infections, are highly endemic. On the other hand, women with light or very light infections will be missed and will not be treated. This is of concern because genital schistosomiasis, a possible risk factor for the transmission of HIV, occurs among women even with light infections.

Evaluating Adult Hematuria

Hematuria, the presence of an increased number of red blood cells in the urine, may be a sign of a serious underlying genitourinary disease. The causes of hematuria may be classified as systemic disorders, those involving the renal parenchyma (glomerular versus tubulointerstitial), or those involving the urinary collecting system. The history, physical examination, and microscopic urinalysis are the key elements in reaching a diagnosis. Further testing is based on these results. The primary care provider's role in hematuria evaluation involves detection, confirmation, and initiation of the evaluation process, including appropriate laboratory studies and referral as necessary. The primary care provider's prompt referral and facilitation of the hematuria evaluation is critical in achieving the best possible outcome and avoiding renal failure or the other sequelae of genitourinary disorders.

Consultation with the Specialist: Familial Nephritis/Alport Syndrome

Consultation with the Specialist: Familial Nephritis/Alport Syndrome

Consultation with the Specialist

Consultation with the Specialist

Optimizing urography.

Urography is regarded as one of the best screening tests for evaluation of urinary tract disease and is commonly used in the search for a cause of hematuria or the presence of upper tract urothelial masses. It is also used in the evaluation of patients with trauma, known or suspected urolithiasis, or renal infection and for the documentation of obstruction or congenital abnormalities. The physician should have a basic understanding of iodinated contrast media and their benefits and effects on the patient. Patient risk factors include a history of (1) renal impairment, (2) significant allergies, (3) asthma, (4) diabetes mellitus, and (5) cardiac disease (particularly congestive heart failure, arrhythmias, unstable angina, recent myocardial infarction, and primary pulmonary hypertension). Changing options for imaging modalities, contrast media, and patient preparation require continued attention to detail and individualization to allow optimization of the urographic examination.

Urinary telomerase and its possible role as a marker for bladder cancer.

Voided urine from patients with bladder cancer and from control patients with either hematuria or with no urologic conditions were examined for telomerase activity in order to explore the possibility that this activity could be used as a marker for the detection of bladder cancer. This assay was found to have an overall sensitivity in detecting bladder cancer of 85% (88/104) with 79% (23/29) grade 1 tumors, 84% (32/38) grade 2 tumors, 87.5% (28/32) grade 3 tumors, and 100% (5/5) carcinoma in situ testing positive. This compared favorably with urinary cytology which had an overall sensitivity of 51% and sensitivities of 13%, 44%, 82%, and 100% for grades 1, 2, 3 tumors and carcinoma in situ, respectively. The specificity of telomerase in patients with benign causes of hematuria was 66%, and in normal volunteers without urologic conditions, it was 100%. Assessment of nuclear matrix protein suggested comparable sensitivity and specificity. Evaluation of bladder tumor antigen showed less sensitivity for low-grade disease and less specificity, as it was influenced by inflammation and instrumentation. Telomerase thus seems to be a means whereby low-grade tumors may be detected in examination of voided urine and may offer an advantage in monitoring for recurrent disease.