Hematuria HPI and A/P
HPI: -Acuity? -Color of urine? -Flank pain? Unilateral or Bilateral? -Visible blood clots in urine? -UTI sxs? -Smoking hx? -Fam hx of Sickle cell dx? -Menses? -Vigorous exercise? -Trauma? Red Flags [select name="variable_1" value="Visible clots in urine|Smoking history|Flank pain| Older than 35| Urologic history| Painful urination"] A/P: -[select name="variable_1" value="Gross hematuria (Patient w/visible red or brown urine)|Microscopic hematuria (>3 RBC/hpf seen on UA) | Myoglobinuria"] -DDx includes: [checkbox name="variable_2" value="Nephrolithiasis |Cystitis| transient hematuria (fever, infection, trauma)| Menses (female on menstrual cycle when sample collected)| Sickle cell trait| Bladder malignancy| BPH | Glomerular etiology| Rhabdomyolysis"] -Gross Hematuria w/clots -> Abdominopelvic CT w/ and w/out contrast for urography and Urgent urology referral -Gross hematuria w/evidence of glomerular bleeding (casts, new/worsening htn, edema, cr albuminuria) -Isolated Microscopic hematuria-> Repeat urinalysis w/microscopy, RFTs in 6 weeks -Persistent microscopic hematuria suggestive of glomerular bleeding -Persistent microscopic hematuria not suggestive of glomerular bleeding: look more closely at the history for causes -Suspect urinary tract infection-> Urine culture, Abx, repeat urinalysis in 6 weeks -Nephrolithiasis-> Abdominopelvic CT without contrast using a low radiation dose is recommended in most patients Consults placed: Urology, Nephrology
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