Hematuria history and symptoms

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Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [1]

Overview

History and symptoms of hematuria depends on the eitology. The history should also include an assessment of associated symptoms, such as gross hematuria, voiding symptoms, or flank pain. Patients' risk factors for known causes of hematuria also should be queried. It is important to know the patient's urologic history, particularly any surgeries or febrile UTIs. It is also critical to ask about the patient's general medical history, to identify potentially contributory diagnoses, such as hypertension, renal insufficiency, bleeding disorders, or sickle cell disease. Current medication use, including anticoagulants and antiplatelet therapies, should be elicited, along with recent coagulation values and any concomitant medications that would potentiate the effects of blood thinners. Family history of nephritis, polycystic kidneys, and rare familial tumor syndromes of the kidney (e.g., von Hippel-Lindau) or urothelium (e.g., Lynch syndrome) also may be informative.[1]

History and Symptoms

Cause of hematuria[1]
History and symptoms
Ruptured abdominal aortic aneurysm
  • Recent onset of severe, constant back, abdominal, or leg pain
  • signs of vascular collapse and shock
  • Tenderness in the costovertebral angle and flank
Clots with obstruction
  • History of hemodynamically significant bleeding
  • Present with acute urinary retention present with inability to void.
Renal infarction
  • Present with accelerated hypertension, loin or flank or abdominal pain
Trauma—renal or urogenital laceration or rupture
  • History of motor vehicle accident.
  • Present with urgency to void and will generally be unable to do so.
Bleeding diathesis
Malignancy
  • Bladder
  • Prostate
  • Ureter
  • Kidney
Male gender, Age older than 35 years, Past or current smoking history, Occupational or other exposure to chemicals or dyes (benzenes or aromatic amines), Analgesic abuse, History of gross hematuria, History of urologic disorder or disease, History of Irritative voiding symptoms, History of pelvic irradiation, History of chronic urinary tract infection, Exposure to known carcinogenic agents or chemotherapy such as alkylating agents, History of chronic indwelling foreign body.

Obstructive symptoms, pain, bloody discharge.

Nephrolithiasis
  • History of urinary tract stones.
  • Present with severe abdominal, back, or flank pain
Glomerulonephritis
  • History of Upper respiratory tract infection, gastroenteritis, synchronous association of pharyngitis, children
  • Hypertension, azotemia, dysmorphic erythrocytes, cellular casts, proteinuria.
  • Symptoms of renal dysfunction such as malaise, fatigue, shortness of breath, and edema
  • Signs may include hypertension and signs of volume overload such as distended jugular veins, lung crackles, S3 gallop, and leg edema
Urinary tract infection
Benign prostatic enlargement
  • Male with elderly age.
  • Present with obstructive symptoms.
Polycystic kidney disease
  • Family history of renal cystic disease
Uretero-pelvic junction obstruction
  • History of UTI, stone, flank pain
Ureteral stricture
  • History of surgery or radiation, flank pain, hydronephrosis; stranguria, spraying urine
Urethral diverticulum
  • Discharge, dribbling, dyspareunia, history of UTI, female predominance
Fistula
  • Pneumaturia, Fecaluria, abdominal pain, recurrent UTI, history of diverticulitis or colon cancer
Exercise-induced hematuria
  • Recent vigorous exercise
Endometriosis
  • Cyclic hematuria in a menstruating woman
Papillary necrosis
  • African-American, sickle cell disease, diabetes, analgesic abuse
Interstitial cystitis
  • Voiding symptoms

References

  1. 1.0 1.1 Wein, Alan (2016). Campbell-Walsh urology. Philadelphia, PA: Elsevier. ISBN 978-1455775675.



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