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Self-Assessment Questions


Hematuria: Review Questions

Ursula C. Brewster, MD, and Mark A. Perazella, MD, FACP

Dr. Brewster is a fellow in nephrology, Yale University School of Medicine, New Haven, CT. Dr. Perazella is an associate professor of medicine and director, Renal Fellowship Program, Yale University School of Medicine; he is also a member of the Hospital Physician Editorial Board.

Choose the single best answer for each question.

1. A 36-year-old Asian man with a history of asthma presents with a complaint of red urine. He describes 5 days of nasal congestion and dry cough. He notes no sore throat, fever, chills, myalgias, arthralgias, or flank pain. He has no family history of renal disease. A urine study indicates 1+ protein, and no bacteria, leukocyte esterase, or nitrates. Thirty to 50 erythrocytes are observed, but no leukocytes are present. His serum creatinine level is normal. Which one of the following is the most likely diagnosis?
  1. IgA nephropathy
  2. Nephrolithiasis
  3. Transitional cell carcinoma of the bladder
  4. Wegener’s granulomatosis
  5. Postinfectious glomerulonephritis
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2. A 64-year-old Caucasian man with a history of hypertension, hyperlipidemia, and nephrolithiasis presents with a complaint of dark-colored urine. He felt well until 2 days ago when he noted increasing fatigue and muscle weakness. Dipstick urinalysis shows a specific gravity of 1.020, no protein, and large blood. Neither leukocyte esterase nor nitrates are identified in the urine. The sediment reveals no erythrocytes or leukocytes. Which of the following diagnostic procedures is appropriate at this point?

  1. Cystoscopy to evaluate for urologic cancer
  2. Flank computed tomography (CT) to evaluate for recurrent nephrolithiasis
  3. Kidney biopsy to delineate the disease process
  4. Serum analysis to evaluate the level of creatine phosphokinase (CPK)
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  3. A 27-year-old African American woman presents with left-sided flank pain and pink-tinged urine. She has recently moved to the Denver, CO, area and is an avid runner. She denies any family history of renal disease or hematuria. She is in good health. She takes an oral contraceptive and occasional acetaminophen for headaches. Urine examination demonstrates 30 to 50 erythrocytes, few leukocytes, 1+ protein, and no cellular casts. Blood count and renal function parameters are normal. Which of the following is the most likely diagnosis for this woman?
  1. Nephrolithiasis
  2. Pyelonephritis
  3. Rhabdomyolysis
  4. Sickle cell trait
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4. A 55-year-old Caucasian man with hypertension presents to the emergency department with excruciating back pain. The pain develops suddenly, comes in waves of colicky sharp pain for approximately 45 minutes, then stops spontaneously. He describes obvious blood in his urine. Urine examination shows blood but no protein present on the dipstick. Many erythrocytes are seen under the microscope, and no leukocytes are observed. A flat plate radiograph of the abdomen reveals 3 stones in the right renal pelvis, the largest of which is 10 mm. A 4-mm radiopaque density is seen in the bladder. What is the most appropriate management for this patient?

  1. Extracorporeal shock wave lithotripsy (ESWL) to break apart larger stones in the renal pelvis
  2. Flank CT to further characterize the location and number of stones
  3. Oral hydration alone to achieve an average daily urine output of 2 L
  4. Ureteroscopy with basket retrieval of the stone in the bladder
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