CHAPTER 27 • GENITOURINARY 159•A thorough and meticulous physical examination
should be completed. Vital signs—especially blood
pressure—should always be obtained. The back,
flank, abdomen and genitalia are examined paying
particular attention to signs of trauma or infection.
DIFFERENTIAL DIAGNOSIS AND TREATMENT
- Differential diagnosis includes urinary tract infection,
nephrolithiasis, urethritis, prostatitis, glomerulone-
phritis, bladder cancer, and medications. - Grossly bloody urine should always be dipstick tested
for blood and red blood cells confirmed by microscopy.
When myoglobin or hemoglobin is present, urine will
test positive for blood but red blood cells are absent on
microscopic examination. Medications, dyes, and food
coloring often discolor urine. In this case, dipstick test-
ing and microscopy will be negative for blood.- See “hematuria algorithm” (Figure 27-1) for evalua-
tion and treatment.
PROTEINURIACLINICAL FEATURES- Proteinuria is defined as more than 150 mg of protein
excreted in a 24-h period. Normal urine protein is
composed of 30% albumin, 30% serum globulins, and
40% tissue proteins. Post-exercise proteinuria is rela-
tively common and has been described for well over
120 years. It occurs in a variety of sports, both contact
and noncontact and is associated with strenuous activity,
FIG. 27-1 Hematuria algorithm.