Name 4 categories of causes of haematuria and give 2 examples each.
- renal - glomerular: glomerulonephritis, SLE, malignant htn, infective endocarditis, vasculitides
- renal - non-glomerular: RCC, metastases, PKD, renal tuberculosis, infarction
- lower urinary tract: cystitis, caliculi, bladder cancer
- prostate: hyperplasia, prostate cancer
What is the classical triad of RCC (present in 10-20% of pts)?
- Flank pain
- Palpable abdo mass
- Note: Autosomal dominant polycystic kidneys may present similarly
Besides the classical triad, what are the other less common Sx for RCC?
- Less common: weight loss, anaemia, fever, htn
- Very rare: hepatic dysfunction, erythrocytosis, neuromyopathies
Describe the morphology of RCC.
- Haemorrhagic and necrotic mass lesion
- Often develops at upper pole of kidney
- Central necrosis within tumour
- U/S appearance may resemble a cyst
- Invasion into renal vein (blood spread)
What are the cell types of bladder cancer?
- Common: 90% are transitional cell ca
- Uncommon: squamous, adenomcarcinoma
What are 4 risk factors for bladder cancer?
- Exposure to aromatic amines
- Infection by Schistosoma haematobium
- Drugs: cyclophosphamide, phenacetin
- Transitional cell ca at other sites e.g. ureter, renal pelvis
Name 2 types of renal calculi (composition).
- Ca oxalate + Ca phosphate (75%)
- Mg ammonium phosphate + Ca phosphate (15%) - more likely to obstruct & form hydronephrosis
Describe the interpretation of urinanalysis in haematuria.
- Blood +ve and no RBC: consider haemoglobinuria, myoglobinuria
- Proteinuria or red cell casts: glomerular diseases
- Pyuria or leukocytes: UTI
- Blood +ve (isolated): neoplasms, calculi
Name 8 Ix used for haematuria.
- Abdo x-ray /US - calculi
- CT/MRI - renal and bladder tumours
- Cytology - transitional cell ca
- IV pyelography - outflow obstruction
- Angiography - renal tumours
- Cystoscopy - bladder/ureter lesions
- Retrograde pyelography - bladder/ureter lesions
- Open biopsy
- Uric acid and urinary Ca - calculi
Which 3 anatomical sites are most likely for a calculi to obstruct? (narrow)
- Pelvic-ureteric junction
- Crossing of iliac vessels
- Entry of bladder