Sandbox:Microscopic hematuria: Difference between revisions

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__NOTOC__
== History and Symptoms ==
http://www.jurology.com/article/S0022-5347(12)04958-0/pdf
{| style="width:80%; height:100px" border="10"
 
|style="height:100px"; style="width:15%" border="1" | '''CATEGORY'''
== Definition ==
|style="height:100px"; style="width:15%" border="1" | '''EXAMPLES'''
Microscopic hematuria is defined as the presence of three or greater red blood cells per high powered
|style="height:100px"; style="width:70%" border="1" | '''COMMON CLINICAL PRESENTATION AND RISK FACTORS'''
field on a properly collected urinary specimen in the absence of an obvious benign cause.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref>
|-
 
| rowspan="6" style="width:15%" ; border="1" | {{Center|Neoplasm}}
== Causes ==
|style="height:100px"; style="width:15%" border="1" | {{Center|Any}}
 
|style="height:100px"; style="width:70%" border="1" | 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
=== Overview ===
|-
The causes of MH are either urologic or nephrologic. The most common urological etiologies are [[BPH|benign prostatic enlargement]], infection and [[urinary calculi]].
|style="height:100px"; style="width:15%" border="1" | {{Center|Bladder cancer}}
 
|style="height:100px"; style="width:70%" border="1" | Older age, male predominance, tobacco, occupational exposures, Irritative voiding symptoms
== Prevalence ==
|-
The prevalence of microscopic hematuria ranges from 1-20% depending on the population studied. The likelihood of finding significant urologic disease in these patients also varies with associated risk factors which include:
|style="height:100px"; style="width:15%" border="1" | {{Center| Ureteral or renal pelvis cancer}}
* Older age
|style="height:100px"; style="width:15%" border="1" | Family history of early colon cancers or upper tract tumors, flank pain
* Male gender
|-
* History of cigarette smoking
|style="height:100px"; style="width:15%" border="1" | {{Center| Renal cortical tumor}}
* History of chemical exposure (cyclophosphamide, benzenes, aromatic amines)
|style="height:100px"; style="width:15%" border="1" | Family history of early kidney tumors, flank pain, flank mass
* History of pelvic radiation
|-
* Irritative voiding symptoms (urgency, frequency, dysuria)
|style="height:100px"; style="width:15%" border="1" | {{Center| Prostate cancer}}
* Prior urologic disease or treatment
|style="height:100px"; style="width:15%" border="1" | Older age, family history, African-American
The prevalence of microscopic hematuria varies depending on age, gender, frequency of testing, threshold used to define MH and presence of risk factors such as smoking.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref>
|-
 
|style="height:100px"; style="width:15%" border="1" | {{Center| Urethral cancer}}
Asymptomatic microscopic hematuria in the general population is common. The prevalence of some degree of hematuria has been reported to be as high as 9% to 18% in large screening studies.<ref name="pmid23312369">Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G et al. (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23312369 Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria.] ''Mayo Clin Proc'' 88 (2):129-38. [http://dx.doi.org/10.1016/j.mayocp.2012.10.004 DOI:10.1016/j.mayocp.2012.10.004] PMID: [https://pubmed.gov/23312369 23312369]</ref>
|style="height:100px"; style="width:15%" border="1" | Obstructive symptoms, pain, bloody discharge
 
|-
The prevalence of MH may be higher in women because of benign conditions but the prevalence of urological cancers in women is low ( e.g. In women risk of bladder cancer is 3- to 4-fold lower, and risk of renal cancer is 2-fold lower, compared with men)<ref name="pmid27751797">Lippmann QK, Slezak JM, Menefee SA, Ng CK, Whitcomb EL, Loo RK (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=27751797 Evaluation of microscopic hematuria and risk of urologic cancer in female patients.] ''Am J Obstet Gynecol''  ():. [http://dx.doi.org/10.1016/j.ajog.2016.10.008 DOI:10.1016/j.ajog.2016.10.008] PMID: [https://pubmed.gov/27751797 27751797]</ref>
| rowspan="6" style="width:15%" ; border="1" | {{Center|Infection/inflammation}}
 
|style="height:100px"; style="width:15%" border="1" | {{Center| Any}}
== Diagnosis ==
|style="height:100px"; style="width:15%" border="1" | History of infection
A positive dipstick does not define MH, and evaluation should be based solely on findings from microscopic examination of urinary sediment and not on a dipstick reading. A positive dipstick reading merits microscopic examination to confirm or refute the diagnosis of MH.Patients who have a positive dipstick test but a negative specimen on microscopy should have three additional repeat tests. If at least one of the repeat tests is positive on microscopy, then work-up should be undertaken. If all three specimens are negative on microscopy, then the patient may be released from care.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref>
|-
 
|style="height:100px"; style="width:15%" border="1" | {{Center| Cystitis}}
American Urological Association (AUA) best practice policy recommendations include urine testing (urine culture or urine cytologic testing), imaging (multiphase abdominal computed tomography [CT] or intravenous pyelography plus renal ultrasonography), and cystoscopy.<ref name="pmid23312369">Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G et al. (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23312369 Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria.] ''Mayo Clin Proc'' 88 (2):129-38. [http://dx.doi.org/10.1016/j.mayocp.2012.10.004 DOI:10.1016/j.mayocp.2012.10.004] PMID: [https://pubmed.gov/23312369 23312369]</ref>
|style="height:100px"; style="width:15%" border="1" | Female predominance, dysuria
 
|-
Because MH has been associated with underlying urologic cancer, the AUA recommends evaluation with cystoscopy and upper tract imaging, preferably with computer tomography (CT) scan, for all patients >35 years of age with this finding.
|style="height:100px"; style="width:15%" border="1" | {{Center| Pyelonephritis}}
 
|style="height:100px"; style="width:15%" border="1" | Fever, flank pain, diabetes, female predominance
== References ==
|-
|style="height:100px"; style="width:15%" border="1" | {{Center| Urethritis}}
|style="height:100px"; style="width:15%" border="1" | Exposure to sexually transmitted infections, urethral discharge, dysuria
|-
|style="height:100px"; style="width:15%" border="1" | {{Center| Tuberculosis}}
|style="height:100px"; style="width:15%" border="1" | Travel to endemic areas
|-
|style="height:100px"; style="width:15%" border="1" | {{Center| Schistosomiasis}}
|style="height:100px"; style="width:15%" border="1" | Travel to endemic areas
|-
| rowspan="2" style="width:15%" ; border="1" | {{Center|Calculus}}
|style="height:100px"; style="width:15%" border="1" | {{Center| Nephroureterolithiasis}}
|style="height:100px"; style="width:15%" border="1" | Flank pain, family history, prior stone
|-
|style="height:100px"; style="width:15%" border="1" | {{Center| Bladder stones}}
|style="height:100px"; style="width:15%" border="1" | Bladder outlet obstruction
|-
|style="height:100px"; style="width:15%" border="1" | {{Center|Benign prostatic enlargement}}
|style="height:100px"; style="width:15%" border="1" |
|style="height:100px"; style="width:15%" border="1" | Male, older age, obstructive symptoms
|-
| rowspan="2" style="width:15%" ; border="1" | {{Center|Medical renal disease}}
|style="height:100px"; style="width:15%" border="1" | {{Center| Any}}
|style="height:100px"; style="width:15%" border="1" | Hypertension, azotemia, dysmorphic erythrocytes, cellular casts, proteinuria
|-
|style="height:100px"; style="width:15%" border="1" | {{Center| IgA nephropathy}}
|style="height:100px"; style="width:15%" border="1" | upper respiratory tract infection, gastroenteritis, synchronous association of pharyngitis, children
|-
| rowspan="5" style="width:15%" ; border="1" | {{Center|Congenital or acquired anatomic abnormality}}
|style="height:100px"; style="width:15%" border="1" |  Polycystic kidney disease
|style="height:100px"; style="width:15%" border="1" | 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
|-
| rowspan="5" style="width:15%" ; border="1" | {{Center|Other}}
| style="width:15%" ; border="1" | {{Center| Exercise-induced hematuria}}
| style="width:15%" ; border="1" | Recent vigorous exercise
|-
| style="width:15%" ; border="1" | {{Center| Endometriosis}}
| style="width:15%" ; border="1" | Cyclic hematuria in a menstruating woman
|-
| style="width:15%" ; border="1" | {{Center| Hematologic or thrombotic disease}}
| style="width:15%" ; border="1" | Family history of personal history of bleeding or thrombosis
|-
| style="width:15%" ; border="1" | {{Center| Papillary necrosis}}
| style="width:15%" ; border="1" | African-American, sickle cell disease, diabetes, analgesic abuse
|-
| style="width:15%" ; border="1" | {{Center| Interstitial cystitis}}
| style="width:15%" ; border="1" | Voiding symptoms
|-|}

Latest revision as of 14:49, 14 December 2016

History and Symptoms

CATEGORY EXAMPLES COMMON CLINICAL PRESENTATION AND RISK FACTORS
Neoplasm
Any
 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
Bladder cancer
 Older age, male predominance, tobacco, occupational exposures, Irritative voiding symptoms
Ureteral or renal pelvis cancer
 Family history of early colon cancers or upper tract tumors, flank pain
Renal cortical tumor
 Family history of early kidney tumors, flank pain, flank mass
Prostate cancer
 Older age, family history, African-American
Urethral cancer
 Obstructive symptoms, pain, bloody discharge
Infection/inflammation
Any
 History of infection
Cystitis
 Female predominance, dysuria
Pyelonephritis
 Fever, flank pain, diabetes, female predominance
Urethritis
 Exposure to sexually transmitted infections, urethral discharge, dysuria
Tuberculosis
 Travel to endemic areas
Schistosomiasis
 Travel to endemic areas
Calculus
Nephroureterolithiasis
 Flank pain, family history, prior stone
Bladder stones
 Bladder outlet obstruction
Benign prostatic enlargement
 Male, older age, obstructive symptoms
Medical renal disease
Any
 Hypertension, azotemia, dysmorphic erythrocytes, cellular casts, proteinuria
IgA nephropathy
 upper respiratory tract infection, gastroenteritis, synchronous association of pharyngitis, children
Congenital or acquired anatomic abnormality
 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
Other
Exercise-induced hematuria
 Recent vigorous exercise
Endometriosis
 Cyclic hematuria in a menstruating woman
Hematologic or thrombotic disease
 Family history of personal history of bleeding or thrombosis
Papillary necrosis
 African-American, sickle cell disease, diabetes, analgesic abuse
Interstitial cystitis
 Voiding symptoms
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