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Diagnosis of Medical Renal Diseases. IN: Tanagho, E.; McAninch, J., eds. Smith’s General Urology. 17th ed. Columbus, OH: McGraw Hill. 2008. pp 521-530.

This chapter about the diagnosis of medical renal diseases is from an updated edition of a comprehensive textbook about urology that offers an overview of the diagnosis and treatment of diseases and disorders common to the genitourinary tract. The authors note that hematuria, proteinuria, pyuria, oliguria, polyuria, pain, renal insufficiency with azotemia, acidosis, anemia, electrolyte abnormalities, and hypertension may occur in a wide variety of disorders affecting any portion of the parenchyma of the kidney, the blood vessels, or the excretory tract. The workup of any patient with a possible renal disease should include a complete medical history and physical examination, a thorough examination of the urine, and blood and urine chemistry examinations as indicated. Specific diseases covered include glomerulonephritis, nephrotic syndrome, renal involvement in collagen diseases, diseases of the renal tubules and interstitium, hereditary renal diseases, anomalies of the proximal tubule, anomalies of the distal tubule, and unspecified renal tubular abnormalities. Renal biopsy may be indicated, in addition to helping with diagnosis, to determine prognosis; to follow progression of a lesion and response to treatment; to confirm the presence of a generalized disease, such as an autoimmune disorder, amyloidosis, or sarcoidosis; and to diagnose renal dysfunction in a transplanted kidney. 24 references.

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Kidney Biopsy Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 4 p.

This fact sheet describes kidney biopsy, a diagnostic test that involves collecting small pieces of kidney tissue, usually through a needle, for examination with a microscope. A kidney biopsy can help the doctor make a diagnosis and choose the best course of treatment for a particular patient. Kidney biopsy is often recommended to help diagnose problems with hematuria, or blood in the urine; proteinuria, or excessive protein in the urine; and impaired kidney function, which causes excessive waste products in the blood. Written in a question-and-answer format, the fact sheet reviews the preparations for a kidney biopsy, what to expect during the procedure itself, what happens immediately after a kidney biopsy, problems to watch for, when to contact the health care provider, and how the test results are reported. A final section of the fact sheet reviews the importance of ongoing research studies, including basic research and the diseases that impair normal kidney function. The fact sheet includes contact information for two resource organizations: the American Kidney Fund at 1–800–638–8299 or www.kidneyfund.org and the National Kidney Foundation at 1–800–622–9010 or www.kidney.org. The fact sheet concludes with a brief description of the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse. 1 figure.

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Medullary Sponge Kidney. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 6 p.

This fact sheet describes medullary sponge kidney (MSK), a birth defect of the tubules inside the kidneys. In a normal kidney, urine flows through these tubules as it is being formed. In MSK, tiny sacs called cysts form in the medulla, the inner part of the kidney, creating a spongelike appearance. The cysts keep urine from flowing freely through the tubules. Written in a question-and-answer format, the fact sheet explains how the kidneys function and discusses the signs and symptoms of MSK, how MSK is diagnosed, and treatment strategies. Although MSK is present at birth, most cases do not appear to be inherited. Problems caused by MSK include hematuria, or blood in the urine; kidney stones; and urinary tract infections (UTIs). However, these problems do not usually appear until the person is in his or her 30s or 40s. Diagnosis of MSK may require a type of x ray called an intravenous pyelogram. Once the condition is diagnosed, treatment focuses on curing UTIs, removing kidney stones, and preventing recurrent infections and stones. A final section of the fact sheet briefly notes the importance of ongoing research studies. The fact sheet includes contact information for four resource organizations: the American Association of Kidney Patients at 1–800–749–2257 or www.aakp.org, the American Kidney Fund at 1–800–638–8299 or www.kidneyfund.org, the Life Options Rehabilitation Resource Center at 1–800–468–7777 or www.lifeoptions.org, and the National Kidney Foundation at 1–800–622–9010 or www.kidney.org. The fact sheet concludes with a brief description of the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse. 3 figures.

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Hematuria and Proteinuria. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 75-84.

This chapter about hematuria and proteinuria is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author recommends that children presenting with hematuria or proteinuria should be considered in different clinical categories: children with hematuria without or with minimal proteinuria, children with hematuria associated with significant proteinuria, and children with proteinuria without accompanying hematuria. The first section of the chapter considers hematuria, covering definition, hemoglobinuria and myoglobinuria, colorants in urine, red blood cell morphology, urinary sediment, differential diagnosis, and recommended workup of hematuria. The section about proteinuria covers definition, differential diagnosis, and workup. Pediatricians are encouraged to orient the clinical investigations of children with these signs in an orderly way to make a correct differential diagnosis and thus identify children who need referral to a pediatric nephrologist. 4 figures. 2 tables. 15 references.

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Neonatal Kidney Problems. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 53-66.

This chapter about neonatal kidney problems is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The author reviews maturation during fetal life, postnatal maturation, symptoms and signs of renal disease in the neonate, gross hematuria, malformation syndromes, diagnostic tests used to confirm kidney and urologic disorders in the neonate, blood pressure and hypertension, renal function during neonatal respiratory disorders, acute renal failure (ARF), acquired diseases, and drugs and the neonatal kidney, including drugs administered to the mother during pregnancy. Acquired diseases discussed include urinary tract infection; renal venous thrombosis; cortical, medullary, and papillary necrosis; Bartter’s syndrome; nephrogenic diabetes insipidus; and oligonephropathy. The chapter includes black-and-white illustrations and photographs and concludes with an extensive list of references. 6 figures. 16 tables. 24 references.

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Urinary Stone Disease. IN: Tanagho, E.; McAninch, J., eds. Smith’s General Urology. 17th ed. Columbus, OH: McGraw Hill. 2008. pp 246-277.

This lengthy chapter about urinary stone disease is from an updated edition of a comprehensive textbook about urology that offers an overview of the diagnosis and treatment of diseases and disorders common to the genitourinary tract. The author notes that urinary stones are common, yet their cause remains uncertain. The author begins with a discussion of the etiology, role of urinary ions, stone varieties, and symptoms and signs at the presentation of urinary tract stones. Symptoms can include pain, hematuria, infection, associated fever, nausea, and vomiting. The author reviews diagnostic approaches to urinary stones and outlines the treatment options, including conservative observation, dissolution agents, relief of obstruction, extracorporeal shock wave lithotripsy, ureteroscopic stone extraction, percutaneous nephrolithotomy, open stone surgery, pyelolithotomy, anatrophic nephrolithotomy, radial nephrotomy, and ureterolithotomy. The chapter includes a section on special situations, including renal transplantation, pregnancy, dysmorphia, obesity, medullary sponge kidney, renal tubular acidosis, associated tumors, pediatric patients, caliceal diverticula, and kidney malformations. Prevention strategies are also outlined, including metabolic evaluation and the use of oral medications. A brief review of bladder, urethral, and prepucial stones is given. The chapter is illustrated with numerous black-and-white drawings and photographs. The chapter concludes with an extensive list of references, categorized by topic. 24 figures. 110 references.

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Dialysis and PKD Patients: An Analysis. Nephrology News & Issues. 21(9): 36, 37. August 2007.

This article focuses on the treatment of patients with polycystic kidney disease (PKD) before the need for renal replacement therapy and during chronic dialysis. The authors discuss the complications of PKD, including renal pain, hematuria, and renal infection; the extrarenal manifestations of PKD, including gastrointestinal involvement, hepatic synthetic dysfunction, cardiac valve abnormalities, hypertension, and brain aneurysms in patients with a strong family or personal history of same; the use of heparin in these patients; the use of dietary sodium restriction, diuretics, and antihypertensive medications used to control volume and blood pressure; the role of remaining kidney function, even in patients who require dialysis to maintain health; patient candidacy for dialysis; the decision between home dialysis versus in-center care; the choice between hemodialysis and peritoneal dialysis; and the importance of adequate nutrition to decrease hospitalizations, improve survival, increase independence, and improve sense of well-being. The authors note that PKD patients are generally good candidates for survival and have a survival advantage compared with patients with end-stage renal disease (ESRD) from other causes.

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Acute Gross Hematuria: Etiology and Management. IN: Kellogg Parsons, J.; James Wright, E., eds. Brady Urology Manual. New York, NY: Informa Healthcare USA. 2006. pp 285-294.

This chapter about the etiology and management of acute gross hematuria is from a reference handbook that offers a comprehensive overview of urology, presented in outline and bulleted formats for ease of access in the busy health care world of hospital emergency rooms and outpatient clinics. The author reviews general principles, common causes of acute gross hematuria, initial patient evaluation and management, management options for intractable hematuria of bladder origin, and management of recurrent hematuria from benign prostatic hyperplasia (BPH). The author notes that acute gross hematuria is usually self-limiting but intractable, severe hematuria from the bladder may require treatment. Invasive treatments can be used after failure of the simplest and least morbid approaches. The drug finasteride can be used for treatment of persistent hematuria associated with BPH. The chapter concludes with a list of references for additional reading. 26 references.

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Acute Nephritis. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 95-102.

This chapter about acute nephritis is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors define acute nephritis as inflammation of the nephrons of the kidney, which develops over a short period of time such as a few days. This inflammation is generally concentrated in the glomerulus and is referred to as acute glomerulonephritis (AGN)—the most common type in children. Clinical manifestations of AGN include reduced urine volume (oliguria), hematuria, edema, and hypertension. The authors discuss the pathology and pathophysiology of AGN, epidemiology and triggering factors, clinical features, differential diagnosis, natural history, management options, and the long-term course and outcomes of postinfectious AGN. The authors caution that the persistence of proteinuria and trace hematuria may be a sign that the initial process was not postinfectious AGN but rather the beginning of a chronic glomerular disease, which requires careful follow up. The chapter concludes with a list of Internet sources for information, as well as a list of print references. 6 tables. 17 references.

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Bladder Cancer: Superficial. IN: Kellogg Parsons, J.; James Wright, E., eds. Brady Urology Manual. New York, NY: Informa Healthcare USA. 2006. pp 151-158.

This chapter about superficial bladder cancer is from a reference handbook that offers a comprehensive overview of urology, presented in outline and bulleted formats for ease of access in the busy health care world of hospital emergency rooms and outpatient clinics. The author discusses epidemiology, different types of bladder cancer, diagnostic strategies, treatment options, surveillance, and urinary tumor markers. About 70 percent of bladder tumors are superficial, and only 10 to 20 percent of these superficial tumors will progress to muscle-invasive disease. Environmental exposures, including tobacco smoke and aniline dyes, are strongly associated with development of bladder cancer. The most common presenting symptom is visible, painless hematuria. Evaluation strategies include history and physical exam, urinalysis, urine culture and cytology, serum electrolytes and liver function tests, upper urinary tract imaging, and cystoscopy. The mainstay of treatment for superficial disease is transurethral resection of bladder tumor (TURBT), with or without adjuvant intravesical chemotherapy. Urinary tumor markers may be used as an adjunct to cystoscopy and urine cytology for diagnosis and/or surveillance. The chapter concludes with a list of references for additional reading. 18 references.

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