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Haematuria

Definition
  • Haematuria: Presence of blood in the urine.
  • Classified as macroscopic (visible) or microscopic (detected on dipstick or microscopy).
Epidemiology
  • Common clinical finding, with varied underlying causes.
  • More concerning in patients >40 years due to increased risk of malignancy.
Causes
  • Glomerular: Glomerulonephritis, IgA nephropathy, Alport syndrome.
  • Stones: Kidney or bladder stones.
  • Infection: UTI, tuberculosis, schistosomiasis.
  • Neoplasms: Bladder cancer, renal cell carcinoma, prostate cancer.
  • Medications: Warfarin, cyclophosphamide, rifampicin.
  • Other: Trauma, exercise-induced, cystitis, prostatitis.
Clinical Presentation
  • Macroscopic haematuria: Pink, red or brown urine.
  • May be associated with dysuria, flank pain, fever, or weight loss.
  • Clots may indicate bladder origin.
Investigations
  • Urine dipstick: Quick initial test but needs confirmation.
  • Urine microscopy: To quantify red cells and look for casts/cells.
  • Ultrasound: Assess kidneys and bladder for masses, cysts, or stones.
  • CT Urogram: Detailed imaging of the urinary tract.
  • Cystoscopy: If bladder malignancy is suspected.
Management
  • Directed by the underlying cause.
  • Antibiotics for UTIs, surgery or lithotripsy for stones, etc.
  • Referral to urology may be required for suspected malignancies or persistent unexplained haematuria.
Complications
  • Anaemia due to chronic blood loss.
  • Progression of undiagnosed underlying disease (e.g., malignancy).
Key Points
  • Always take haematuria seriously as it may be the first sign of a significant pathology such as malignancy.
  • Thorough history and examination are vital to ascertain the cause.

Haematuria is a symptom with a wide differential diagnosis. It’s essential to approach with a systematic assessment to exclude serious pathologies.

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