User:Cheikhnjie/sandbox

Copied from Hematuria

Diagnosis

Sometimes the cause of hematuria can be determined based on the medical history and urine testing. This is especially true for people less than 35, in whom the risk of cancer is low. It is imperative to ascertain key risk factors such as smoking, occupational exposures to benzene, history of recent weight loss and/or history of urologic disorders such as Benign enlargement of the prostate or recurrent kidney stones to help with risk stratification. The most common causes of hematuria are related to kidney stones causing obstruction and infection of the prostate or bladder. Additionally, athletes with vigorous exercise regimens may sometimes have either gross or microscopic hematuria.[citation needed]

The first step in evaluation of Hematuria is to perform a Urine dipstick to assess for blood in the urine, followed by a urinalysis with microscopic evaluation for confirmation. If hematuria is present, and is associated with acute onset of unilateral flank pain, it is generally indicative of a presence of a kidney stone and evaluation should be done with a non-contrast CT scan of the abdomen/pelvis. If hematuria is associated fever, pain with urination, urinary frequency or presence of white blood cells in the urine; it is highly suggestive of a urinary tract infection and additional work-up with urine cultures should be done to further evaluate. If neither of these features are present, the next step is to separate the evaluation into gross vs microscopic hematuria.[citation needed]

For patients with gross hematuria and evidence of blood clots, further imaging with an Abdominal CT scan should be done and an urgent referral to a Urologist made. Otherwise, the next step involves determining if source of bleeding is glomerular in nature as evidenced by presence of inappropriately shaped/dysmorphic red blood cells, presence of protein in the urine, new or worsening hypertension or swelling. If source is glomerular patients should be referred to a Nephrologist for further evaluation. Non-glomerular source of bleeding will usually require further work-up by a Urologist.[citation needed]

In patients with microscopic hematuria, it is important to rule out any possible confounders such as menstruation in women, possible presence of semen in sample or recent rigorous exercise. In menstruating women, tests should be repeated during non-bleeding parts of their cycles. In individuals with history of recent rigorous exercise, urinalysis should be repeated 4–6 weeks following cessation of exercise. All women of child-bearing age should undergo a pregnancy test, and if positive should receive an ultrasound of their kidneys and bladder with further invasive diagnostic work-up deferred until completion of pregnancy.[citation needed]

If diagnostic work-up has been unyielding so far or the aforementioned risk factors are present, it is important to begin a thorough work-up for possible malignancy especially of the bladder and kidney by referring to a Urologist to look at the urethra and bladder with a cystoscopy and also performing additional imaging using the more sensitive CT urography, which provides a more thorough view of the complete urinary system.[citation needed]

For individuals with persistent hematuria with no immediate identifiable cause, urinalysis should be repeated once a year, and if it is negative for 2 years then you can stop repeating the tests. However, if it is positive for 3 years, repeat anatomic evaluation should be done.[citation needed]

For patients with gross hematuria, if there is evidence of blood clots further imaging with an Abdominal CT scan should be done and an urgent referral to a Urologist made.

For example, in a young woman who is found to have hematuria along with a simple urinary tract infection, she likely only needs antibiotics for her UTI, and does not need further workup for her hematuria. Similarly, high-intensity exercise can occasionally cause hematuria.☃☃ As such, an athlete with blood in their urine after vigorous exercise usually just needs a repeat urine test.mmetimes the cause of hematuria can be elucidated solely on the basis of the medical history and urine testing, or urinalysis. This is especially true for young people, in whom the risk of malignancy is very low. For example, in a young woman who is found to have hematuria along with a simple urinary tract infection, she likely only needs antibiotics for her UTI, and does not need further workup for her hematuria. Similarly, high-intensity exercise can occasionally cause hematuria. As such, an athlete with blood in their urine after vigorous exercise usually just needs a repeat urine test.

For patients with suspected kidney stones, a common cause of hematuria, CT scanning or Ultrasound is often the first step. For most other patients with continued, unexplained hematuria, because of the risk of cancer of the bladder, prostate, ureters, or kidney is a concern, further imaging is usually done. This includes directly looking at the urethra and bladder with cystoscopy and more sensitive radiographic imaging with computed tomography urography.

If combined with flank pain, loin pain hematuria syndrome is a rare but possible cause.