0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

■ Peripheral edema

■ Proteinuria—3+ or 4+ on dipstick

■ Fatty casts or oval fat bodies on UA: Related to associated hyperlipi-

demia

■ Hypoproteinemia

■ BUN and creatinine are often normal.

TREATMENT

■ May include fluid restriction, IV diuretics

COMPLICATIONS

■ Increased risk of thrombosis

■ The most notable is renal vein thrombosis, characterized by hema-

turia, flank pain, and worsening renal function.

HEMATURIA

Hematuria can be microscopic or gross in nature. Microscopic hematuria is

defined as >3 RBC/hpf on spun urine sediment, while gross hematuria corre-

lates to 1 mL of blood in 1 L of urine. Gross hematuria has a higher inci-

dence of serious underlying pathology.

Hematuria can be thought of as belonging to four main groups:

■ Traumatic

■ Hematologic: eg, coagulopathy, sickle cell disease

■ Renal: eg, glomerulonephritis, AVM

■ Postrenal: eg, stones, bladder carcinoma, BPH, UTI

Table 18.1 lists the most common etiologies of hematuria by age group.

SYMPTOMS/EXAM

■ Vary with underlying etiology

Renal vein thrombosis should

be considered in all patients

with nephrotic syndrome

presenting with hematuria,

flank pain, and worsening

renal function.

TABLE 18.1. Common Causes of Hematuria by Age

Common Causes of Hematuria by Age

<20 yr Glomerulonephritis

UTI

20–40 yr GU trauma

Malignancy

Stone

UTI

40–60 yr Carcinoma (bladder, kidney)

Stone

UTI

BPH (males)