Clínica de Urologia Dr. Charles Rosenblatt

Smoking history
Occupational exposure to chemicals or dyes
(benzenes or aromatic amines)
History of gross hematuria
Age >40 years
History of urologic disorder or disease
History of irritative voiding symptoms
History of urinary tract infection
Analgesic abuse
History of pelvic irradiation

Intravenous urography
Considered by many to be best initial study for evaluation of
urinary tract
Widely available and most cost-efficient in most centers
Limited sensitivity in detecting small renal masses
Cannot distinguish solid from cystic masses;therefore,
further lesion characterization by ultrasonography,computed
tomography or magnetic resonance imaging is necessary
Better than ultrasonography for detection of transitional cell
carcinoma in kidney or ureter
Ultrasonography

Excellent for detection and characterization of renal cysts
Limitations in detection of small solid lesions (<3 cm)

Preferred modality for detection and characterization of solid
tomography renal masses
Detection rate for renal masses comparable to that of
magnetic resonance imaging,but more widely available
and less expensive
Best modality for evaluation of urinary stones,renal and
perirenal infections,and associated complications
Sensitivity of 94%to 98%for detection of renal stones,
compared with 52%to 59%for intravenous urography
and 19%for ultrasonography

TABLE 1
Substances and Medications Affecting Urine Color

Artificial food coloring
Beets
Berries
Chloroquine (Aralen)
Furazolidone (Furoxone)
Hydroxychloroquine (Plaquenil)
Nitrofurantoin (Furadantin)
Phenazopyridine (Pyridium)
Phenolphthalein
Rifampin (Rifadin)

TABLE 2
Mechanisms by Which Selected Drugs May Cause Hematuria

Mechanism	Drugs
Interstitial nephritis	Captopril (Capoten) Cephalosporins Chlorothiazide (Diuril) Ciprofloxacin (Cipro) Furosemide (Lasix) NSAIDs Olsalazine (Dipentum) Omeprazole (Prilosec) Penicillins Rifampin (Rifadin) Silver sulfadiazine (Silvadene) Trimethoprim-sulfamethoxazole (Bactrim, Septra)
Papillary necrosis	Acetylsalicylic acid (aspirin) NSAIDs
Hemorrhagic cystitis	Cyclophosphamide (Cytoxan) Ifosfamide (Ifex) Mitotane (Lysodren)
Urolithiasis	Carbonic anhydrase inhibitors Dichlorphenamide (Daranide) Indinavir (Crixivan) Mirtazapine (Remeron) Ritonavir (Norvir) Triamterene (Dyrenium)

TABLE 3
Glomerular and Nonglomerular Causes of Hematuria

Glomerular causes

Nonglomerular causes

Primary glomerulonephritis

IgA nephropathy (Berger's disease) Postinfectious glomerulonephritis
Membranoproliferative glomerulonephritis
Focal glomerular sclerosis
Rapidly progressing glomerulonephritis

Secondary glomerulonephritis

Lupus nephritis
Henoch-Schönlein syndrome
Vasculitis (polyarteritis nodosa, Wegener's
granulomatosis)
Essential mixed cryoglobulinemia
Hemolytic-uremic syndrome
Thrombotic thrombocytopenic purpura
Medications (i.e., interstitial nephritis,
analgesic nephropathy)

Familial conditions

Thin glomerular basement membrane nephropathy
Hereditary nephritis (Alport's syndrome)
Fabry's disease

Exercise12-14

Conditions affecting renal parenchyma

Renal tumors (renal cell carcinoma, angiomyolipoma, oncocytoma)
Vascular disorders (nutcracker syndrome,15
malignant hypertension, sickle cell trait or disease,
arteriovenous malformation, renal vein thrombosis or infarct, transplant rejection)
Metabolic disorder (hypercalciuria, hyperuricuria)
Familial condition (polycystic kidney disease, medullary sponge kidney)
Infection (acute or chronic pyelonephritis,
tuberculosis, cytomegalovirus infection, infectious mononucleosis)
Papillary necrosis

Extrarenal conditions

Tumors (renal pelvis, ureter, bladder, prostate)
Benign prostatic hyperplasia
Stone or foreign body
Infections (cystitis, prostatitis, urinary schistosomiasis, tuberculosis, condyloma acuminatum)
Systemic bleeding disorder or coagulopathy
Trauma
Radiation therapy
Indwelling catheters
Drugs (heparin, warfarin [Coumadin], cyclophosphamide [Cytoxan])

TABLE 4
Physical Examination Findings and Associated Causes of Hematuria

Physical examination finding	Cause of hematuria
General (systemic) examination
Severe dehydration	Renal vein thrombosis
Peripheral edema	Nephrotic syndrome, vasculitis
Cardiovascular system
Myocardial infarction	Renal artery embolus or thrombus
Atrial fibrillation	Renal artery embolus or thrombus
Hypertension	Glomerulosclerosis with or without proteinuria
Abdomen
Bruit	Arteriovenous fistula
Genitourinary system
Enlarged prostate	Urinary tract infection
Phimosis	Urinary tract infection
Meatal stenosis	Urinary tract infection

TABLE 5
Risk Factors for Urothelial Carcinoma

Cigarette smoking
Occupational exposures

Aniline dyes
Aromatic amines
Benzidine

Dietary nitrites and nitrates
Analgesic abuse (e.g., phenacetin)
Chronic cystitis and bacterial infection associated with urinary calculi and obstruction of the upper urinary tract
Urinary schistosomiasis
Cyclophosphamide (Cytoxan)
Pelvic irradiation

TABLE 6
Risk Factors for Contrast Uropathy

Dehydration
Diabetes with azotemia
Cardiac decompensation
History of allergy
Asthma
Hay fever
Seafood allergy
Others, including allergic reactions to antibiotics
Previous reaction to contrast media
Renal insufficiency