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A 45 y/o woman presents to the Emergency room with complaints of severe flank pain and nausea. Patient’s past medical history reveals chronic smoking and occupational exposure to aniline dyes. Physical examination reveals mild right costo-vertebral angle tenderness. The patient is afebrile. Labarotory investigations reveal urine dipstick positive for blood but negative for leucoesterase and nitrite. Urinalysis reveals numerous RBCs per HPF. There are no RBC casts or WBC casts. Urine HCG is negative. The next step in managing this patient’s Hematuria is:
A) Start intravenos antibiotic therapy
B) Obtain Non Contrast CT scan
C) CT urogram + Cystoscopy
D) Intravenos pyelogram
E) Ultrasonography
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B bcoz afebrile no need of antibiotics, why ultrasiund when we have non contrast ct, no urogram which is invasive untill we have a roadmap, no pyelogram when dipstick is positive, whats is correct?
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EVALUATION OF MICROSCOPIC
HEMATURIA
After microscopic hematuria has been identified (2 of
3 urine samples with 3 or more RBC/hpf), the
American Urological Association recommends the following
evaluation:
_ Infection identified: Treat with antibiotics and
repeat urinalysis.
_ RBC casts, proteinuria, or elevated creatinine: Begin
evaluation for glomerulonephritis and consider
referral to a nephrologist.
_ No infection or primary renal disease identified in
first 2 steps: Urine cytology, bladder cystoscopy (if at
risk for bladder cancer based on environmental
exposures and/or age _40), and CT scan (helical CT
if stones suspected, contrast-enhanced CT if stones
not suspected).
_ If entire thorough diagnostic evaluation negative:
Follow-up urinalysis, urine cytology, blood pressure,
and serum creatinine every 6–12 months.
The above was from Jason. This patient has ruled out infection and glomerulonephritis.
I think the answer is c.
