master's thesis
Hematurija - dijagnostički izazov

Josip Pokrovac (2016)
Sveučilište u Rijeci
Medicinski fakultet
Katedra za kirurgiju
Metadata
TitleHematurija - dijagnostički izazov
AuthorJosip Pokrovac
Mentor(s)Dean Markić (thesis advisor)
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.
Keywordshematuria anamnesis urine cytology ultrasound
Committee MembersRomano Oguić (committee chairperson)
Josip Španjol (committee member)
Lidija Orlić (committee member)
GranterSveučilište u Rijeci
Medicinski fakultet
Lower level organizational unitsKatedra za kirurgiju
PlaceRijeka
StateCroatia
Scientific field, discipline, subdisciplineBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Urology
Study programme typeuniversity
Study levelintegrated undergraduate and graduate
Study programmeMedicine
Academic title abbreviationdr. med.
Genremaster's thesis
Language Croatian
Defense date2016-07-15
Parallel 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.
Parallel keywords (Croatian)hematurija anamneza citologija urina ultrazvuk
Resource typetext
Access conditionAccess restricted to students and staff of home institution
Terms of usehttp://rightsstatements.org/vocab/InC/1.0/
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:184:460495
CommitterBosa Licul