Hematuria physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2] Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]
Overview
Patients with hematuria usually appear normal. Physical examination findings of patients with hematuria usually depends on the underlying etiology.
Physical Examination
Physical examination of the patient with hematuria should be focused on finding the underlying cause. The physical examination findings vary depending on the etiology.
Appearance of the Patient
- Patients with hematuria usually appear normal.
Vital Signs
- Blood pressure, heart rate, respiration rate, temperature, and consciousness level are important to assess hemodynamic stability, volume status, and possible presence of shock or sepsis as the treatment of hematuria is driven by the underlying pathophysiology and is in large part conservative.[1]
Skin
- Skin and mucosal membrane examination are useful to check for signs of bleeding disorders, such as petechiae, purpura, ecchymoses, and gingival bleeding.
HEENT
- HEENT examination of patients with hematuria is usually normal. However, there might be some physical examination findings depending on the etiology.
- Bilateral sensorineural hearing loss might be seen in patients with Alport syndrome.[2]
- Eye problems such as anterior lenticonus or cataracts might also be seen in patients with Alport syndrome.
- Periorbital edema might be seen in patients with nephritic syndrome.[3]
Neck
- Neck examination of patients with hematuria is usually normal. However, jugular venous distention indicates volume overload.
Lungs
- Pulmonary examination of patients with hematuria is usually normal.
Heart
- Cardiovascular examination of patients with hematuria is usually normal.
Abdomen
- Abdominal examination of patients with hematuria is usually normal. However, there might be some physical examination findings depending on the etiology.[1]
- Suprapubic tenderness might indicate kidney stones or urinary tract infection (UTI).
- A palpable abdominal mass
Back
- Costovertebral angle tenderness might be a finding on physical examination, which might indicate urinary tract infection or kidney stones.[1]
Genitourinary system
- Enlarged, nodular, tender, or fluctuant prostate. Prostate palpation is important for evaluation of prostatitis and prostate cancer in male patients with hematuria.[1]
- Urine flow rate and postvoid residual measurement may be helpful in further workup as well.[4]
- Identification of the location of bleeding (being sure that it is not originating from the reproductive tract) is important in female patients with hematuria.
Neuromuscular
- Neuromuscular examination of patients with hematuria is usually normal.
Extremities
- Extremities examination of patients with hematuria is usually normal. However, pitting edema of the extremities might be seen in some diseases with glomerulonephritis such as poststreptococcal glomerulonephritis (PSGN).[3]
References
- ↑ 1.0 1.1 1.2 1.3 Ingelfinger JR (July 2021). "Hematuria in Adults". N Engl J Med. 385 (2): 153–163. doi:10.1056/NEJMra1604481. PMID 34233098 Check
|pmid=value (help). - ↑ Watson S, Padala SA, Bush JS. PMID 29262041. Missing or empty
|title=(help) - ↑ 3.0 3.1 Rawla P, Padala SA, Ludhwani D. PMID 30855843. Missing or empty
|title=(help) - ↑ Wein, Alan (2016). Campbell-Walsh urology. Philadelphia, PA: Elsevier. ISBN 978-1455775675.