• 　Ａ 45 year old man

• Presented with hematuria from 3 months ago

• No Dysuria or Frequency

• No pain

• Physical examination is normal

1. What is the most common cause of painless hematuria?

Urine Analysis

• Color yellow• Appearance clear• PH 5• SG 1.015• Protein Neg• Glucose Neg• Blood Pos (+)• Ketone Neg• Bilirubun Neg

• WBC 2-3 /hpf• RBC 8-10/hpf• Ep Cells 2-3

/hpf• Bacteria Neg• Crystals Neg• Casts Neg• Mucus Neg

• No dysmorphic RBCs were seen in his urinary sediment

Hematuria

• According to the American Urological Association, the presence of three or more red blood cells (RBCs) per high-powered field (HPF) in two of three urine samples is the generally accepted definition of hematuria.

Common Causes of Hematuria

Glomerular causes

• Familial causes• Fabry's disease• Hereditary nephritis (Alport's syndrome)• Nail-patella syndrome• Thin basement-membrane disease• Primary glomerulonephritis• Focal segmental glomerulonephritis• Goodpasture's disease• Henoch-Schönlein purpura• IgA nephropathy (Berger's disease)• Mesangioproliferative glomerulonephritis• Postinfectious glomerulonephritis• Rapidly progressive glomerulonephritis• Secondary glomerulonephritis• Hemolytic-uremic syndrome• Systemic lupus nephritis• Thrombotic thrombocytopenic purpura• Vasculitis

Renal causes

• Arteriovenous malformation• Hypercalciuria• Hyperuricosuria• Loin pain-hematuria

syndrome• Malignant hypertension• Medullary sponge kidney• Metabolic causes• Papillary necrosis• Polycystic kidney disease• Renal artery embolism• Renal vein thrombosis• Sickle cell disease or trait• Tubulointerstitial causes• Vascular cause

Common Causes of Hematuria

Urologic causes

• Benign prostatic hyperplasia• Cancer (kidney, ureteral, bladder,

prostate, and urethral)• Cystitis/pyelonephritis• Nephrolithiasis• Prostatitis• Schistosoma haematobium

infection• Tuberculosis• Other causes• Drugs (e.g., NSAIDs, heparin,

warfarin [Coumadin], cyclophosphamide [Cytoxan])

• Trauma (e.g., contact sports, running, Foley catheter)

Microscopic examination may detect:

• RBC casts

• Dysmorphic RBCs.

• What is Dysmorphic RBCs?

Urine Cytology

Cystoscopy

Bladder Biopsy

TUR-B

Cystectomy

• 63-year-old man

• was found to have microscopic hematuria on urinalysis.

• The remainder of the urinalysis was normal, as was the physical exam.

• The patient did not complain of any fever, weight loss, pain, malaise, weakness, or urinary tract symptoms.

• Laboratory results showed the following:– Electrolytes: normal 　– Hct57%Hb19 g/dL– BUN12 mg/dLCreatinine0.7 mg/dL– WBC7,450/mm3 with a normal differential– Urine cytology: negative

• Work-up for the hematuria was begun with:

• noninvasive imaging studies, which included a renal ultrasound examination and an intravenous pyelogram. A mass was seen in the left kidney with both imaging studies.

• A CT scan has been performed

• The patient underwent nephrectomy.    

1. What is the classic triad of presenting symptoms of renal cell carcinoma?

2. What is the typical age of patients with renal cell carcinoma (RCC)?

3. What is the most common renal tumor in children?

4) What paraneoplastic syndromes are associated with renal cell carcinoma?

Staging

• Stage 1 - Confined to the kidney • Stage 2 - Involvement of perinephric fat

but Gerota's fascia intact • Stage 3 - Spread into renal vein • Stage 4 - Spread into adjacent or

distant organs • Prognosis depends on pathological

stage, tumour size, nuclear grade and histological type

5)Where is the location? 6)What is the name of the tumor?

• A previously healthy 35-year-old man complained of recent fatigue and swelling of his feet and ankles.

• He also noted puffy eyes.

• Physical exam revealed an a febrile man with lower extremity edema extending to the knee, periorbital edema, and a small amount of ascites.

• Laboratory results were: • Urinalysis:

– protein - 4+ – Micro:rare RBCs, no WBCs, many oval fat bodies

• Serum– Creatinine:0.8 mg/dL– BUN18 mg/dL– Albumin2.8 g/dL– Hematocrit40%– Liver function testsnormal– Triglycerides:400 mg/dL– Cholesterol:375 mg/dL– 24-hr urine protein11.2 gm/24 hr

1. What is the clinical syndrome of this patient?

2. What is the most common cause of the disease in adult and in children?

• Drug history was negative.

• ANA, HIV, and hepatitis serologies were negative.

• A renal biopsy was performed.

3)Is any inflammation seen?

4)What is the typical sign of

this disease?

5) Are the spikes part of the deposits?

6) Based on the results of light microscopy, immunofluorescence, and electron microscopy of the renal biopsy specimen, what is the patient's diagnosis?