Hematuria and other urinary symptoms
B FUN HIDE PISS
B
Burning sensation
F
Frequency
U
Urgency
N
Nocturia
H
Hematuria
I
Imcomplete bladder sensation
D
Dribbling
E
Episodes in the past?
P
Painful urination/Painful CVA/Pyuria/Prostate exam in the past?
S
Stream (Is it weak stream?/Straining?
Physical Examination for Hematuria:
Abdominal exam:
Auscultation, Palpation, Percussion, Check for CVA tenderness.
Cardiovascular exam:
Auscultation
Pulmonary exam:
Auscultation
Differential Diagnosis for Hematuria:
Nephrolithiasis:
Suddenonset of flank pain radiating to the groin, scrotum or vulva, hematuria, dark urin, N/V.
Bladder Cancer:
History of taking cydophosphamide, weight loss, older age.
BPH:
older age, dysuria, frequency, urgency, Nocturia, dobbling, weak stream, maybe hematuria
Prostate Cancer:
older age, Long history of chronic frequenxy, urgencym nocturia, dribbling, weak stream, weigh loss, hematuria
Polycystic kidnery disease:
family history, history of HTN, Abdominal mass, Hematuria
Renal Cell Carcinoma:
Hematuria, weight loss, older age
Glomerulon ephritis:
Hematuria, HTN, Edema
IgA nephropathy:
most common glomerulonephritis, gross hematuria after 1 to 2 days upper respiratory.
Pyelonephritis:
Dysuria, fever, flank pain, hematuria, Positive CVA tenderness
UTI:
Dysuria, frequency, urgency, pelvic pain, hematuria.
Coagulation disorder:
history of bruising.
Diagnostic Work up for Hematuria
Genital exam
Rectal exam (check for BPH or Prostate Cancer)
Urinalysis
PSA
CBC, PT/PTT
Urine Culture
Urine cytology
Kidney ultrasound
BUN/Cr
Cystoscopy
CT of abdomen/pelvis