Abstract
Haematuria is a common compliant in the elderly. Microscopic haematuria is first suspected after a dipstick in urine and confirmed with urine microscopy. The causes of haematuria in the elderly may be renal or extra-renal including clotting disorders. This article is a review on haematuria in the elderly.
Author Contributions
Copyright© 2019
Dabota Buowari Yvonne.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests The authors have declared that no competing interests exist.
Funding Interests:
Citation:
Introduction
Aging is a physiological process that causes changes in many organs in the body including the kidneys with subsequent structural and functional changes. For these reasons the elderly are more likely to develop kidney diseases that may present with haematuria The types of haematuria in the elderly are the same as haematuria in the general population. There are basically two types of haematuria namely: 1. Gross or Macroscopic Haematuria: The haematuria is visible to the naked eyes in macroscopic haematuria. 2. Microscopic Haematuria: This is when the haematuria is not visible to the naked eyes. There are various definitions for making a diagnosis of microscopic haematuria from different authorities. The American Urological Association defines microscopic haematuria as three or more red blood cells per high power field (HPF) on microscopic analysis of two or three properly collected urine specimens Haematuria in the elderly is caused by a vast number of causes arising either from the urinary system or elsewhere. It may be a sign of disease of the genitourinary system or non-urologic disease 1. Urinary tract infection including schistosomiasis. 2. Malignancies of the urinary tract. This includes malignancy of the bladder, urethra, ureter, kidneys. Malignancies of the urinary tract usually present with macroscopic haematuria, 88% with bladder cancers and 40% with renal cancer 3. Ureteric and renal stones 4. Nephropathies 5. Benign prostatic hyperplasia 6. Radiation induced cystitis 7. Clotting disorders such as haemophilia 8. Inflammation of the kidney, urethra, bladder or prostrate 9. Drug induced haematuria: Some drugs that can induce haematuria a. Cyclophosphamide b. Amitriptyline, c. Rifampin, d. Non-Steroidal Anti-Inflammatory Drugs Haematuria that is intractable may be caused by radiation cystitis, carcinoma of the bladder, and cyclophosphamide induced cystitis Management of haematuria in the elderly involves taking a comprehensive history, physical examination, conducting investigations and drugs. Sometimes blood may be required. Haematuria may be the only presenting compliant especially when it is macroscopic or in association with other symptoms like fever, nausea and vomiting. It may also be incidental finding when screening for other diseases or routine screening especially if it is microscopic The history should include detailed history concerning genitourinary symptoms such as: 1. Frequency 2. Incontinence 3. Change in the character of the urine stream 4. Pain a. Dysuria: Macroscopic haematuria that is painless is likely due to malignancy of the genitourinary tract b. Abdominal pain: Nature of the pain if it is dull or sharp and also its location. 5. Urgency 6. If there are no other symptoms 7. If it is episodic or continuous 8. During urination if the haematuria initial, terminal or total 9. Periorbital and pedal oedema 10. Use of nephrotoxic drugs medications 11. Co-morbidity 12. Family history of coagulation disorders and renal diseases 13. Passage of stones, tissues and clots 1. Checking for pallor 2. Check for edema, periorbital edema and pedal edema 3. Blood pressure measurement 4. Examination of the cardiovascular system 5. Examination of the urinary system 6. Abdominal examination Symptoms of diseases of the lower urinary tracts are common in the elderly 1. Urine tests: urine microscopy, culture and sensitivity 2. Blood tests: a. full blood count, serum, urea and creatinine b. Kidney function tests including glomerular filtration rate c. Clotting profile d. Whole blood or blood products if available should be cross matched and saved for macroscopic haematuria depending on the state of pallor/anaemia and also the cardiovascular stability of the patient. e. Prostate specific antigen for males When the creatinine is elevated and there is proteinuria, it signifies that the haematuria is likely from a medical disease. 3. Radiological Imaging a. Abdominal ultrasonography b. Computed tomography scan (CT-Scan) c. Magnetic resonance imaging d. Intravenous pyelogram In the management of haematuria, imaging of the urinary tract, urine cytology and cystoscopy are necessary as some small cancers may not be visible on some imaging techniques The management of haematuria is dependent on if it is macroscopic or microscopic, and also on the cause of the haematuria if it is known. Microscopic haematuria can be managed on an out-patient basis. In macroscopic haematuria, the patient should be resuscitated