Management of Hematuria

Today we had a great presentation of a complex patient and we discussed many different points. 

  1. What are the guidelines surrounding the use of gadolinium in patients with renal disease? The FDA recommends avoiding gadolinium in patients with a GFR of <30 mL/min, patients on dialysis or those with AKI as their GFR is not reliable.  In addition American College of Radiology recommends avoiding gadolinium in patients with a GFR of <44 mL/min.

  2. What is the illness script for minimal change disease in adults?  The prototypical patient is a middle age male or female with edema following a recent URI.  They will present with edema, proteinuria, HLD and HTN.  Patient’s with MCD have a higher incidence of infections and thrombosis.

  3. How to manage gross hematuria?  Once identified discontinue all agents that can contribute to hematuria, including SQ heparin and ASA.  The most concerning complication is clots causing urinary obstruction.  If the hematuria is significant discuss continuous bladder irrigation following irrigation of all clots.  However this does come with a risk of bladder rupture.