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Patients with hematuria may usefully be categorized into 1 of the following 4 groups:

Gross hematuria

Microscopic hematuria with clinical symptoms

Asymptomatic microscopic hematuria with proteinuria

Asymptomatic microscopic (isolated) hematuria

See Workup for more detail.

General principles of treatment are as follows:

Hematuria is a sign and not itself a disease; thus, therapy should be directed at the process causing it

Asymptomatic (isolated) hematuria generally does not require treatment

In conditions associated with abnormal clinical, laboratory, or imaging studies, treatment may be necessary, as appropriate, with the primary diagnosis

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, tumor, or significant urolithiasis)

Dietary modification is usually not indicated, except for children who may tend to develop hypertension or edema as a result of the primary disease process (eg, nephritis)

Patients with persistent microscopic hematuria should be monitored every 6-12 months for the appearance of signs or symptoms indicative of progressive renal disease

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Guidelines on hematuria from the American College of Physicians (ACP) advises that clinicians should include gross hematuria in their routine review of systems and specifically ask all patients with microscopic hematuria about any history of gross hematuria. [, ]

The ACP also recommend that [, ] :

Clinicians should not use screening urinalysis for cancer detection in asymptomatic adults.

Clinicians should confirm heme-positive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults.

Clinicians should refer for further urologic evaluation in all adults with gross hematuria, even if self-limited.

Clinicians should consider urology referral for cystoscopy and imaging in adults with microscopically confirmed hematuria in the absence of some demonstrable benign cause.

Clinicians should pursue evaluation of hematuria even if the patient is receiving antiplatelet or anticoagulant therapy.

Clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection in the initial evaluation of hematuria.

Next:

Hematuria is one of the most common urinary findings that result in children presenting to pediatric nephrologists. Generally, hematuria is defined as the presence of 5 or more RBCs per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. In the office setting, a positive reaction on the urine dipstick test is usually the first indication of the presence of hematuria. Hematuria can be gross (ie, the urine is overtly bloody, smoky, or tea colored) or microscopic. It may be symptomatic or asymptomatic, transient or persistent, and either isolated or associated with proteinuria and other urinary abnormalities. The role of the primary care physician in the management of a child with hematuria includes the following:

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Article Text

ECG interpretation for the emergency department
Electrocardiographic abnormalities encountered in acute myocardial infarction

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The evaluation of patients with chest pain is a challenging area of accident and emergency (AE) work. In the clinical assessment of such patients, interpretation of the electrocardiogram (ECG) is an essential adjunct to the history and examination. Approximately 20% of patients presenting with chest pain will have acute myocardial infarction (AMI), 35% angina/unstable angina, and 45% non-cardiac chest pain. 1 , 2 Reaching a rapid and accurate clinical diagnosis is of great importance, particularly as urgent reperfusion treatments such as thrombolytic agents and coronary angioplasty have been shown to improve prognosis in patients with AMI—if applied appropriately and early.

The electrocardiographic criteria identifying the group of patients likely to benefit from urgent reperfusion treatments are: (1) ST segment elevation in at least two anatomically contiguous leads and (2) new left bundle branch block (LBBB); further, ST segment depression in the right precordial leads (V1–V3), indicative of posterior AMI with posterior lead ST segment elevation, may represent yet another electrocardiographic indication for urgent coronary reperfusion. The ST segment elevation associated with an evolving myocardial infarction is usually readily identifiable. AE physicians responsible for the administration of thrombolysis, however, need to be aware of the common pseudoinfarct ST elevation patterns that are associated with non-AMI ECG syndromes in the chest pain patient as LBBB and left ventricular hypertrophy. This article will review the ECG changes associated with AMI. Others in this series review the ECG changes associated with posterior wall and right ventricular wall infarction, the diagnosis of AMI in the presence of LBBB, non-infarction ST segment elevation syndromes, and the patient with chest pain and a non-diagnostic ECG.

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