...
Is there abdominal pain? The presence of abdominal pain with hematuria should first suggest renal calculus, but other causes, such as renal embolism, renal contusion, or laceration, must be considered. ... DIAGNOSTIC WORKUP
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...
Is there fever? A significant fever would suggest either pyelonephritis, particularly in females, or acute prostatitis in males.
Is the urine grossly bloody or are there a significant number of red cells on ... DIAGNOSTIC WORKUP
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...
Are there significant numbers of white blood cells (WBCs) in the urine? This would suggest a UTI. If there are white cell casts or clumps, the infection may be a pyelonephritis. A urine culture and colony count should be ... DIAGNOSTIC WORKUP
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...
Are there significant RBCs in the urine? If so, one should consider glomerulonephritis, collagen disease, tuberculosis, neoplasm, trauma, renal calculus, and polycystic kidney disease. If not, the most likely etiology is a UTI.
... DIAGNOSTIC WORKUP
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... Red urine may be due to hematuria,
hemoglobinuria (hemolytic anemia), myoglobinuria (muscle trauma, myocardial infarction), and coproporphyria or uroporphyria (porphyria). Phenazopyridine hydrochloride (PyridiumŪ) also colors the urine red or
... READ EXCERPTS »
...
Is the 24-hr urine volume increased? If the 24-hr urine volume is increased, then one has identified polyuria. The differential diagnosis of this condition is found on
page 372
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Is there dysuria? If there is dysuria, one ... DIAGNOSTIC WORKUP
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...
Hematuria is the intermittent or persistent excretion of red or brown urine that can occur with a variety of clinical symptoms. The amount of blood can be grossly evident or microscopic. About 2.5% of the general population has asymptomatic... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Dysuria is a painful or burning sensation during or immediately after urination. This is a common symptom in primary care; nearly 20% of women aged 20–55 will have one episode of dysuria per year. Women have episodes of acute dysuria much more... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Hematuria is defined as >5 red blood cells per high-power field in a freshly voided, spun urine specimen. Macroscopic (gross) hematuria is less common, is more likely to be attributed to an identified cause, and is always “pathologic.” Cola-colored urine,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Dysuria is defined as pain with urination and is a very common complaint in female children. It is commonly due to either urinary tract infection or perineal irritation from a variety of causes.
Differential Diagnosis
... Workup and Diagnosis ... Treatment
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...
Proteinuria in children is defined as a quantitative 24-hour urine collection with >4 mg/m2/hour (>100 mg/m2/day) of protein. Semiquantitative definitions include urine dipstick ≥1+ (30 mg/dL) for specific gravity (SG) ≤... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Pyuria is defined as the presence of white blood cells in the urine. This condition is commonly caused by urinary tract infection, asymptomatic bacteriuria, or vaginal contamination of the urine specimen.
Differential Diagnosis
... Workup and Diagnosis ... Treatment
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... Using the anatomic approach, the physician can arrive at most of the causes of hematuria ( Table 35 ). One need only visualize the urinary tract and proceed from the kidney on down to get a differential list. Let us apply the mnemonic VINDICATE to
... READ EXCERPTS »
... Dysuria is difficult or painful micturition. One could cover most of the causes simply by considering the inflammatory lesions of the genitourinary tract in ascending order. Thus, there may be a urethritis or urethral carbuncle, a trigonitis or prostatitis, a cystitis or
... READ EXCERPTS »
... There are many causes of proteinuria. The mnemonic VINDICATE is a helpful way of developing a list of possibilities.
PROTEINURIA
V—Vascular category should call to mind CHF, hypertension
... READ EXCERPTS »
... Pyuria is included here although it is not a symptom or a definitive finding on physical examination. Examination of the urine, however, is so frequently a part of every physical examination that the causes of pyuria should be available for immediate recall for all primary care
... READ EXCERPTS »
... Apart from hematuria, red urine may signify hemoglobinuria or myoglobinuria, suggesting the various hemolytic anemias, the march hemoglobinuria, paroxysmal “cold” hemoglobinuria and nocturnal hemoglobinuria, and the Crush syndrome. Red
... READ EXCERPTS »
... Frequency of urination may be due to polyuria (increased output of urine), obstruction to the output of urine (requiring frequent voiding to get the urine out) because the net capacity of the bladder is reduced, or irritative lesions in or near the
... READ EXCERPTS »
... Bleeding from the Ear
This is not usually a serious condition. Anatomy is again applied to formulate a diagnosis. The blood may be from the external or middle ear and usually is caused by diseases of the skin or drum. Trauma is the most
... READ EXCERPTS »
... A cardinal sign of renal and urinary tract disorders, hematuria is the abnormal presence of blood in urine Strictly defined, it means three or more red blood cells (RBCs) per high-power microscopic field in urine Microscopic hematuria is confirmed by an... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
... READ EXCERPTS »
... Cloudy, murky, or turbid urine reflects the presence of bacteria, mucus, leukocytes or erythrocytes, epithelial cells, fat, or phosphates (in alkaline urine). It’s characteristic of urinary tract infection (UTI) but can also result from prolonged storage of a... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... Postmenopausal vaginal bleeding — bleeding that occurs 6 or more months after menopause — is an important indicator of gynecologic cancer. But it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the endometrium,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers
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... Pseudohematuria (Dyes and Pigments)
Beets
Food dyes
Phenytoin
Rifampin
Pyridium
Urates
... READ EXCERPTS »
... Benign/Physiologic
Fever
Exercise
Orthostatic
Contrast dye
Usually Nonnephritic
Chronic pyelonephritis
... READ EXCERPTS »
... Urethral
Congenital urethral stenosis, web, atresia
Posterior urethral valves
Inflammation or stricture
Trauma
Bladder Neck
Prostatic
... READ EXCERPTS »
... Cystitis and urethritis, the two forms of lower urinary tract infection (UTI), are nearly 10 times more common in females than in males and affect approximately 10% to 20% of all females at least once. Lower UTI is also a prevalent bacterial disease in children, with females... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Postmenopausal bleeding is defined as bleeding from the reproductive tract that occurs 1 year or more after cessation of menses. Sites of bleeding include the vulva, vagina, cervix, and endometrium. The prognosis varies with the cause. ... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A cardinal sign of renal and urinary tract disorders, hematuria is the abnormal presence of blood in the urine. Strictly defined, it means three or more red blood cells (RBCs) per high-power microscopic field in the urine. Microscopic hematuria is confirmed by... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Dysuria—painful or difficult urination—is commonly accompanied by urinary frequency, urgency, or hesitancy. This symptom usually reflects lower urinary tract infection (UTI)—a common disorder, especially in women. (See Preventing... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Pictures
... READ EXCERPTS »
... Cloudy, murky, or turbid urine reflects the presence of bacteria, mucus, leukocytes or erythrocytes, epithelial cells, fat, or phosphates (in alkaline urine). It’s characteristic of urinary tract infection (UTI), but it can also result from prolonged storage of... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... Postmenopausal vaginal bleeding—bleeding that occurs 6 or more months after menopause—is an important indicator of gynecologic cancer. But it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling
... READ EXCERPTS »
... Siegfried Schmidt and Ku-Lang Chang
Hematuria, defined as “blood in the urine,” is encountered frequently in family practice. It can occur as gross (macroscopic) hematuria with obvious reddish discoloration or can be... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... David M. Quillen
Approach Dysuria is defined as “painful urination.” Acute dysuria is a frequent problem seen in ambulatory practices, accounting for more than three million office visits a year. The most common... History ... Physical examination ... Testing ... Diagnostic assessment
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... Irene M. Hamrick
The prevalence of proteinuria in the general population is 3%, and 5% in healthy adolescents (1). Heavy and persistent proteinuria is associated with the development of end-stage renal disease in
... READ EXCERPTS »
... Victoria S. Kaprielian
Postmenopausal bleeding is defined as vaginal bleeding that occurs in a woman who has had no menses for a year or more. This is a common outpatient problem, estimated to account for approximately 5% of gynecologic... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
... READ EXCERPTS »
... Differential Overview
❑ Urinary tract infection
❑ Nephrolithiasis
❑ Anticoagulation
❑ Long distance running
&... Diagnostic Approach ... Clinical Findings
... READ EXCERPTS »
... Differential Overview
❑ Lower urinary tract infection
❑ Acute pyelonephritis
❑ Urethritis
❑ Vaginitis
❑ Acute prostatitis ... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
❑ Diabetes
❑ Drugs/toxins
❑ Acute tubular necrosis
❑ Glomerulonephritis
... Diagnostic Approach ... Clinical Findings
... READ EXCERPTS »
... Cystitis and urethritis, the two forms of lower urinary tract infection (UTI), are nearly 10 times more common in women than in men and affect approximately 10% to 20% of all women at least once. Lower UTI is also a prevalent bacterial disease in children, with girls also... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
... READ EXCERPTS »
... A cardinal sign of renal and urinary tract disorders, hematuria is the abnormal presence of blood in the urine. Microscopic hematuria is confirmed by an occult blood test, whereas macroscopic hematuria is immediately visible. However, macroscopic hematuria must be... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Dysuria (painful or difficult urination) is commonly accompanied by urinary frequency, urgency, or hesitancy. This symptom usually reflects lower urinary tract infection (UTI) — a common disorder, especially in women.
Dysuria also results... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Postmenopausal vaginal bleeding — bleeding that occurs 6 or more months after menopause — is an important indicator of gynecologic cancer, but it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the endometrium, and physiologic... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Hematuria—presenceof blood in urine—can be microscopic (urine is not discolored) orgross (urine has red or brown discoloration). >5 red cells per high-powerfield in centrifuged urinary sediment is considered abnormal. Hematuria can occur... Principal Causes of Hematuria ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
... READ EXCERPTS »
...Dysuria (pain on urination) is usually producedby inflammation of urethra or bladder or both. Principal Causes of Dysuria Urinarytract infection Urethritis Cystitis Pyelonephritis Chemical irritation Diaper ... Clinical Features and Diagnosis ... Diagnostic Approach ... Table 15.1. Criteria for Diagnosis of Urinary Tract Infections ... References
... READ EXCERPTS »
... Proteinuriais a common finding in childhood and adolescence. Usual pathogenesis involves increasein permeability of glomerular basement membrane. Less common isdecreased absorption or increased secretion of protein by renaltubules,... Principal Causes of Proteinuria ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
... READ EXCERPTS »
... A cardinal sign of renal and urinary tract disorders, hematuria is the abnormal presence of blood in urine. Strictly defined, it means three or more red blood cells (RBCs) per high-power microscopic field in urine. Microscopic hematuria is... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Dysuria—painful or difficult urination—is commonly accompanied by urinary frequency, urgency, or hesitancy. This symptom usually reflects lower urinary tract infection (UTI)—a common disorder, especially in women.
Dysuria results from... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Cloudy, murky, or turbid urine reflects the presence of bacteria, mucus, leukocytes or erythrocytes, epithelial cells, fat, or phosphates (in alkaline urine). It's characteristic of urinary tract infection (UTI) but can also result from prolonged storage... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Postmenopausal vaginal bleeding—bleeding that occurs 6 or more months after menopause—is an important, albeit not a definitive, indicator of gynecologic cancer. It can also result from infection, a local pelvic disorder, estrogenic... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
...
Dysuria is difficult or painful micturition. One could cover most of
the causes simply by considering the inflammatory lesions of the
genitourinary tract in ascending order. Thus, there may be a urethritis or
urethral carbuncle, a trigonitis or... Pictures
... READ EXCERPTS »
...
There are many causes of proteinuria. The mnemonic VINDICATE is a
helpful way of developing a list of possibilities.
V—Vascular category should call to mind CHF, hypertension, and
renal vein thrombosis.
... Pictures
... READ EXCERPTS »
...
Pyuria is included here although it is not a symptom or a definitive
finding on physical examination. Examination of the urine, however, is so
frequently a part of every physical examination that the causes of pyuria
should be... Pictures
... READ EXCERPTS »
...
Apart from hematuria, red urine may signify hemoglobinuria or
myoglobinuria, suggesting the various hemolytic anemias, the march
hemoglobinuria, paroxysmal “cold” hemoglobinuria and nocturnal
hemoglobinuria, and the Crush syndrome. Red... Pictures
... READ EXCERPTS »
...
Frequency of urination may be due to polyuria (increased output of
urine), obstruction to the output of urine (requiring frequent voiding to
get the urine out) because the net capacity of the bladder is reduced, or
irritative lesions in or near the... Pictures
... READ EXCERPTS »
...
Using the anatomic approach, the physician can arrive at most of
the causes of hematuria (Table 35). One need only visualize the
urinary tract and proceed from the kidney on down to get a differential
list. Let us apply the mnemonic VINDICATE to the kidney.... Pictures
... READ EXCERPTS »
...
Bleeding from the ear. This is not usually a serious
condition. Anatomy is again applied to formulate a diagnosis. The
blood may be from the external or middle ear, and usually is caused by
diseases of the skin or
... READ EXCERPTS »
... Ann Salerno, MD Hematuria - BASICS Hematuria - description Hematuria is defined as >5 RBCs per high-power field (hpf), using a standard urinalysis technique on a centrifuged sample. This correlates with a urine... Hematuria - DIAGNOSIS ... Hematuria - TREATMENT ... Hematuria - FOLLOW UP ... Hematuria - bibliography ... Hematuria - CODES
... READ EXCERPTS »
... Mercedes M. Blackstone, MDKathy N. Shaw, MD, MSCE Urinary Tract Infection - BASICS Urinary Tract Infection - description UTI is growth of bacterial urinary tract pathogen(s):For suprapubic aspirate, & ... Urinary Tract Infection - DIAGNOSIS ... Urinary Tract Infection - TREATMENT ... Urinary Tract Infection - FOLLOW UP ... Urinary Tract Infection - bibliography ... Urinary Tract Infection - CODES ... Urinary Tract Infection - FAQ
... READ EXCERPTS »
... Etiology
Pediatric urinary tract infection begins with colonization of the periurethral
area with gastrointestinal bacteria. These bacteria may then ascend into the
bladder, kidneys, or both. A variety of virulence factors may promote... Presentation ... Diagnosis ... Management of Urinary Tract Infection ... Radiographic Evaluation after Urinary Tract Infection
... Management of Vesicoureteral Reflux ... Selected Readings ... Pictures
... READ EXCERPTS »
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