Diagnostic approach of hematuria

Posted by e-Medical PPT Monday, July 25, 2011
Causes of hematuria
Glomerular
    IGA nephropathy
    Postinfectious glomerulonephritis
    Familial glomerulonephritis
    RPGN
    MPGN
    Glomerulonephritis caused by systemic dz
    Subacute bacterial endocarditis
    Exercise
Nonglomerular
    Renal (tubulointerstitial)
       infection, tumor, drug-induced,
           familial, vascular, metabolic
    Extrarenal
      Infection, stone, inflammation, tumor,
           stricture, endometriosis, BPH,           
           congenital abnormalities
Coagulopathy related
     Drug induced (warfarin/heparin)
     Secondary to systemic disease
Trauma
Factitious
     ex. Menstruation

Evaluation of microscopic hematuria in adults
Hematuria on dipstick testing
  repeat dipstick test
     urine microscopy for erythrocytes, casts,and bacteria
 Confirmation of hematuria
Assessment
   History, Physical examination
   Serum urea, electrolytes, Cre.
   GFR
   Immunology (ANCA, ANA, anti-GBM,
       ASO)
   Ultrasound for kidney and bladder
   Urine cytology
   Coagulation exam
Glomerular type hematuria
  Dysmorphic RBCs with a low MCV and  RBC casts
  Consideration for a renal biopsy

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