Title Hematurija - dijagnostički izazov
Author Josip Pokrovac
Mentor Dean Markić (mentor)
Committee member Romano Oguić (predsjednik povjerenstva)
Committee member Josip Španjol (član povjerenstva)
Committee member Lidija Orlić (član povjerenstva)
Granter University of Rijeka Faculty of Medicine (Department of Surgery) Rijeka
Defense date and country 2016-07-15, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Urology
Abstract Nalaz krvi u mokraći naziva se hematurija. Hematurija se dijeli na mikrohematuriju i
makrohematuriju. Makrohematurija je okom vidljiva promjena boje urina, dok
mikrohematurija predstavlja pojam koji je inspekcijski nemoguće odrediti već je potrebno
uĉiniti analizu urina. Iako se definicije razlikuju, mikrohematurija predstavlja nalaz 5 ili više
eritrocita u sedimentu urina. Uzroci hematurije mogu biti: neglomerularni i glomerularni.
Najuĉestaliji neglomerularni uzroci hematurije su: infekcije urotrakta, nefrolitijaza te maligne
bolesti. Najĉešći glomerularni uzroci hematurije su: benigna familijarna hematurija,
glomerulonefritisi te Alportov sindrom. Dijagnostiĉki protokol u evaluaciji hematurije
ukljuĉuje: anamnezu, fizikalni pregled, laboratorijsku dijagnostiku te slikovne dijagnostiĉke
pretrage. Anamnezom je potrebno odrediti radi li se o mikrohematuriji ili makrohematuriji.
Ako je rijeĉ o makrohematuriji od pacijenta je potrebno saznati trajanje hematurije, popratne
simptome te postoji li pozitivna obiteljska anamneza hematurije. Ukoliko se radi o
mikrohematuriji potrebno je detaljnije dijagnostiĉki evaluirati pacijenta. Laboratorijska
dijagnostika ukljuĉuje analizu urina te citologiju urina, ukoliko postoji sumnja na malignu
bolest. Analizom urina se dobiva informacija o broju i morfologiji stanica, prisutnosti
cilindara te proteina u urinu. Citologija urina je laboratorijska dijagnostiĉka pretraga
inferirorna cistoskopiji, no zbog svoje neinvazivnosti dijagnostiĉki „primamljivija―
pacijentima sa hematurijom. Posljednji korak u evaluaciji pacijenta sa hematurijom jest
korištenje slikovnih dijagnostiĉkih pretraga uz invazivne dijagnostiĉke pretrage kao što je npr.
cistoskopija. Metoda izbora jest ultrazvuk, ĉije se korištenje primjenjuje prije invazivnih
metoda kao što su: uretrocistoskopija i eksplorativna ureterorenoskopija.
Prvu liniju pretraga saĉinjavaju: snimka abdomena u leţećem poloţaju, ultrazvuk te
intravenska urografija. Najprihvatljivija slikovna dijagnostiĉka pretraga prve linije jest
ultrazvuk. Ultrazvuk ne emitira ionizirajuće zraĉenje te zbog svoje relativno niske cijene i
dostupnosti je najĉešće korištena slikovna dijagnostiĉka metoda u evaluaciji hematurije.
Slikovne dijagnostiĉke pretrage druge linije su: CT urografija i MR urografija. Navedene
pretrage su najosjetljivije i najspecifiĉnije u detekciji tumorskih tvorbi i udaljenih metastaza,
no zbog svojih nedostataka, a to su: visoka cijena i visoka doza zraĉenja (CT), spadaju u
sekundarni dijagnostiĉki protokol evaluacije uzroka hematurije. Od invazivnih dijagnostiĉkih
metoda najĉešće se koristi cistoskopija.
Abstract (english) Blood finding in urine is called hematuria. Hematuria is divided into microhematuria and
gross hematuria. Gross hematuria is „by eye― visible discoloration of urine, while
microhematuria represents the term that is impossible to determine by inspection yet is
necessary to do urinalysis. Although definitions vary microhematuria represents finding of 5
or more erythrocytes in the urine sediment. The causes of hematuria can be: non-glomerular
and glomerular. The most common non-glomerular causes of hematuria are: urinary tract
infections, nephrolithiasis, and malignant diseases. The most common glomerular causes of
hematuria are: benign familial hematuria, glomerulonephritis and Alport's syndrome. The
diagnostic protocol in evaluation of hematuria includes: anamnesis, physical examination,
laboratory diagnostics and imaging diagnostic tests. Anamnesis is necessary to make
distinction between microhaematuria and gross hematuria. In the case of gross hematuria, it is
important to find out how long does discoloration of urine last, are there any accompanying
symptoms, whether pain or burning sensation is present while urinating and if there is a
positive family medical history of hematuria. In the case of microhematuria it is important to
evaluate patient minutely. Laboratory diagnosis includes urinalysis and urine cytology, if
there is suspicion of malignancy. From urinalysis information about number and morphology
of cells, presence of casts and proteins in urine is obtained. Urine cytology is a laboratory
diagnostic test inferior to cystoscopy, because of its noninvasiveness, it is diagnostically more
"attractive" to patients with hematuria. The last diagnostic step in evaluation of patients with
hematuria are imaging diagnostic tests combined with invasive diagnostic tests such as:
cystoscopy. The method od choice is ultrasound, which is used before invasive diagnostic
tests such as: urethrocystoscopy and explorative ureterorenoscopy. The first line consists of:
conventional radiography, intravenous urography and ultrasound. The most acceptable
imaging diagnostic test from the first line of imaging diagnostic test is ultrasound. Ultrasound
does not emit ionizing radiation and because of its relatively low price and availability is the
most widely used diagnostic imaging in the evaluation of hematuria. Imaging diagnostic tests
of second line are: CT urography and MR urography. Listed tests are the most sensitive and
most specific in the detection of tumor masses and distant metastases, but because of its flaws,
namely: high price and high radiation doses (CT), they belong in secondary diagnostic
protocol of evaluating causes of hematuria. Cystoscopy is the most frequent use invasive
diagnostic procedure.
Keywords
hematurija
anamneza
citologija urina
ultrazvuk
Keywords (english)
hematuria
anamnesis
urine cytology
ultrasound
Language croatian
URN:NBN urn:nbn:hr:184:460495
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
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Created on 2016-10-11 09:10:14