Microscopic hematuria

Urinalysis to rule out infection as a cause of the patient s voiding symptoms also check urinalysis for microscopic hematuria, which typically accompanies benign prostatic hyperplasia. 

HbAS) Females may have frequent urinary tract infections Microscopic hematuria occurs rarely Gross hematuria can occur spontaneously or with heavy intensity exercise Normal Hgb values... 

Nonspecific findings such as thrombocytopenia, elevated erythrocyte sedimentation rate or C-reactive protein, and abnormal urinalysis (i.e., proteinuria or microscopic hematuria)... 

Presentation may be mild (microscopic hematuria) or severe (massive hemorrhage) and develops during or shortly after chemotherapy infusion. 

Urinalysis reveals more than three RBCs per high-power field and microscopic hematuria. 

Monitoring When indicated, monitor drug toxicity or efficacy through urinalysis. In rheumatoid arthritis patients, discontinue the drug if unexplained gross hematuria or persistent microscopic hematuria develops. Perform liver function tests and an annual x-ray for renal stones. 

Drug may produce same signs of renal damage as severe acute lead poisoning (proteinuria, microscopic hematuria). Transient anemia/bone marrow depression, hypercalcemia (constipation, drowsiness, dry mouth, metallic taste) occurs occasionally. 

Mild symptoms, starting about 3 hours after a dose and lasting for several hours, occur in more than one third of patients. Central nervous system symptoms (dizziness, headache, drowsiness) are most common nausea and vomiting, diarrhea, colic, pruritus, and urticaria also occur. Infrequent adverse effects are low-grade fever, an orange to red discoloration of the urine, proteinuria, microscopic hematuria, and a transient decrease in leukocytes. Seizures have been reported rarely. 

A 52-year-old woman with a history of hypertension for 15 years developed acute left flank pain, nausea, and vomiting. On a previous similar occasion 2 weeks before she had had a trace of proteinuria and microscopic hematuria. A contrast-enhanced CT scan of the abdomen had not shown stones, hydronephrosis, or morphological abnormalities. She had had no rash. Her urine contained cocaine. Creatine kinase and lactate dehydrogenase activities were raised and there... 

The patients white blood cell count may be normal or only slightly elevated. Nonspecific findings include anemia (normocytic, normochromic), thrombocytopenia, an elevated erythrocyte sedimentation rate or Greactive protein, and altered urinary analysis (proteinuria/microscopic hematuria). 

Proapted by a report of hematuria In a subject receiving EA 3834, research was begun on the effects of these drugs on ureteral and bladder motility (25). Microscopic hematuria was shown to occur within several minutes after Intravenous administration of EA 3834 and usually cleared within 1 h. The dogs had ureteral or bladder catheters In place and often had a few red blood cells In the urine before administration of the agent. However, the red cells became much more numerous after administration. No additional Information Is available ... 

In one subject, fever and spastic movements of Che head were noted he was treated vigorously with antidotes. At 3 h, he became unresponsive, showed decerebrate rigidity, had a high heart rate, and had urinary retention he was treated vigorously with antidotes. Five years later (1968), he was hospitalized for microscopic hematuria and was shown by renal biopsy to have focal glomerullcls. 

A 58-year-old woman developed a raised INR and microscopic hematuria while taking warfarin and co-amoxiclav (330). This was attributed to an interaction of the two drugs. 

One renal transplant recipient developed the nephrotic syndrome, with microscopic hematuria and non-ohguric acute renal insufficiency within 15 days after starting foscarnet therapy for cytomegalovirus infection (13). A kidney biopsy showed crystals in aU glomeruh and in the proximal tubules. The crystals consisted of several forms of foscarnet salts. Renal function and proteinuria nevertheless improved progressively, and a second transplant biopsy 8 months after the first one showed... 

Mild and usually asymptomatic proteinuria, leukocyturia, microscopic hematuria, or moderate increases in serum creatinine were observed in 15-25% of patients (20). There was moderate deterioration of glomerular and tubular renal function in most interferon alfa-treated patients assessed prospectively with a number of renal function markers (263). 

The efficacy and adverse effects of ivermectin 200 micro-grams/kg, repeated 2 weeks later, have been stndied in 50 patients with chronic strongyloidiasis, aged 30-79 years (13). The eradication rate was 96% at 2 weeks after the first dose and 98% after the second dose. There was no recurrence after follow-up of 4 months. One patient had nausea and vomiting 3 hours after the first dose and again after the second dose, but they were transient and required no therapy. In four patients there were mild laboratory abnormalities (slight increases in liver function tests in two, microscopic hematuria in one, and mild leukopenia and lymphocytosis in one). Of the 50 patients 12 were positive for human T lymphotropic virus type-I. 

Serious renal injury can develop as a late complication of pre-existing benign penicillamine nephropathy (220,225). Unfortunately, microscopic hematuria has limited predictive value for imminent serious renal injury, since in most patients who take penicillamine it is a transient or coincidental finding (SEDA-7, 260). The diagnosis of penicillamine-induced renal injury is often difficult because of the frequent association of rheumatoid arthritis with renal disorders (198,204,226-228), including spontaneous membranous glomerulopathy (229), or with injury caused by concomitant analgesics (230). 

Cantagrel A, Fournie B, Pourrat J, Conte JJ, Fournie A. Hematurie microscopique d origine renale au cours de la polyarthrite rhumatoide. [Renal microscopic hematuria in rheumatoid polyarthritis.] Rev Med Interne 1991 12(l) 31-6. 

Data from the decade of 1940-1950 reviewed by Simon et al [7]in 1990 indicate an incidence of crystalluria of 0.4 to 49%, hematuria (with or without flank pain) of 1 to 32%, oliguria, anuria, or azotemia of 0.4 to 29%, and renal stones of 0.4 to 20%, for an overall incidence of renal toxicity (excluding crystals) between 1 and 32%. For a number of reasons detailed elsewhere [7], these early data are difficult to assess. However, even with the use of preventive measures such as urine alkahnization, renal toxicity was 2% [7], and the incidence of gross hematuria and microscopic hematuria despite high fluid intake were 2-3% and 24%,... 

The decline in kidney function usually occurs within the first few days of therapy, and may be detected after only a few doses or, more rarely, later in the course of treatment [7-17]. Patients may be asymptomatic, but nausea, vomiting, and abdominal, back, or flank pain are common, while oliguria is uncommon. The rise in the serum creatinine concentration is usually modest, and dialysis has only rarely been necessary [18, 19] Most patients recover kidney function within 3 to 14 days of stopping acyclovir therapy, reducing the dose, or increasing hydration [7, 8,10-17, 20]. Chronic renal dysfunction has been only rarely attributed to oral acyclovir use Urinalysis usually shows mild proteinuria, microscopic hematuria, and variable degrees of pyuria. Birefringent needle-shaped crystals may... 

Since unresolved nephrocalcinosis may lead to residual abnormalities in the kidney including microscopic hematuria, hypercalcemia, and impaired tubular function [100,104,105], renal ultrasonography within a few months of initiating loop diuretics may be warranted [100 104]. If long-term diuretic therapy is needed, a thiazide diuretic alone or in combination with furosemide may reduce the risk of renal calcifications by decreasing urinary calcium and oxalate excretion [100,102,104,107,108]. However, two studies of premature infants failed to show a reduction in either urinary oxalate or calcium excretion when thiazides were added to furosemide therapy [107,109]. 

Most patients present initially with edema, frequently acute in onset, following a nonspecific upper respiratory tract infection, allergic reaction, or vaccinations, which might have activated the T lymphocytes. Nephrotic syndrome with massive proteinuria (substantially more than 40 mg/m per hour for children and 3 g/day for adults), edema, hypoalbuminemia, and hyperlipidemia is common. The patient s weight may be increased dramatically because of sodium and fluid retention. Nephrotic features such as gross hematuria are uncommon. However, microscopic hematuria may be seen in up to 20% to 25% of patients. Hypertension and decreased renal function are uncommon in children but are more common in older adults. In some patients, volume depletion may result in mild to moderate azotemia. 

FSGS accounts for less than 15% of the cases of idiopathic nephrotic syndrome in children and about 15% to 20% in adults however, it may account for 36% to 80% of the cases in African-Americans. Almost all the patients present with proteinuria, and many of them have all the features of nephrotic syndrome. The proteinuria is nonselective, containing albumin and other higher-molecular-weight proteins, and is usually less severe when compared to patients who have minimal-change disease. Hypertension, microscopic hematuria, and renal dysfunction may be seen in up to half of the patients. Reduced renal function becomes more prevalent as the disease progresses. 

Patients with IE typically have laboratory abnormalities however, none of these changes is specific for the disease. Anemia (normocytic, normochromic), leukocytosis, and thrombocytopenia may be present. The white blood cell (WBC) count is often normal or only shghtly elevated, sometimes with a mild left shift. Acute bacterial endocarditis, however, may present with an elevated WBC count, consistent with a fulminant infection. The erythrocyte sedimentation rate (ESR) is elevated in 90% to 100% of patients, and the level of C-reactive protein also may be elevated. Often the urinary analysis is abnormal, with proteinuria and microscopic hematuria occurring in approximately 50% of individuals. 

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