BÖLÜM


DOI :10.26650/B/CH12CH47.2023.014.07   IUP :10.26650/B/CH12CH47.2023.014.07    Tam Metin (PDF)

Hematüri̇si̇ Olan Yaşlı Hastaya Yaklaşım

Ali İlterElif Arı Bakır

Gelişmiş ülkelerde 65 yaş üstü nüfus gün geçtikçe artmaktadır. Tüm dünyada 2050 senesinde her üç kişiden birinin 65 yaşın üzerinde olacağı tahmin edilmektedir1 . Yaşlanma; böbrekler de dahil olmak üzere vücuttaki birçok organda yapısal ve fonksiyonel değişikliklere neden olan fizyolojik bir süreçtir. Bu nedenle yaşlıların hematüri ile ortaya çıkabilen böbrek hastalığı geliştirme olasılığı daha yüksektir2,3. Hematüri, idrarda kırmızı kan hücrelerinin varlığıdır ve hastane başvurularında hastalarda sık görülen bir bulgudur3,4. Hematüri; bir hastalık durumunun tek belirtisi olabilir veya başka belirtilerle birlikte görülebilir5 . Yaşlılarda hematüri, benign veya malign olabilen altta yatan bir hastalığın belirtisidir5 . Hematüri için çeşitli tanımlamalar mevcut olduğu halde kesin tanısı; hematürinin gözle görülebildiği durumlar dışında idrarın mikroskobik incelenmesi ile konur.



Referanslar

  • 1. World Population Ageing 2019 Highlights. https://www.un.org/en/development/desa/population/publica-tions/pdf/ageing/WorldPopulationAgeing2019-Report.pdf google scholar
  • 2. Oliveira LB, Cobo EC, Machado JR, et al. Clinical and epidemiological prevalence of glomerulopathies elderly in the city of Uberaba-MG. J Bras Nephrol. 2015;37(2):166-170. google scholar
  • 3. Ingelfinger JR. Hematuria in Adults. N Engl J Med. 2021 Jul 8;385(2):153-163. google scholar
  • 4. Sing RI, Singal RK. What is significant hematuria for the primary care physician? Can J Urol. 2012;19(suppl 1):36-41. google scholar
  • 5. Yafi, FA, Aprikian AG, Tanguay S, Kassouf, W. Patients with microscopic and gross hematuria: practice and referral patterns among primary care physicians in a universal health care system. Can Urol Assoc J. 2011;5(2):97-101. google scholar
  • 6. Bolenz C, Schröppel B, Eisenhardt A, Schmitz-Drager BJ, Grimm MO. The investigation of hematuria. Dt-sch Arztebl Int. 2018;115(48):801-807. google scholar
  • 7. Barocas DA, Boorjian, SA, Alvarez RD, et al. Microhematuria: AUA/SUFU Guideline. J Urol. 2020;204(4):778-786. google scholar
  • 8. Yeoh M, Lai NK, Anderson D, Appadurai V. Macroscopic haematuria: a urological approach. Aust Fam Physician. 2013 Mar;42(3):123-126. google scholar
  • 9. Davis R., Jones JS, Barocas DA, et al. Diagnosis, evaluation and follow-up of asymptomatic microhema-turia (AMH) in adults: AUA guideline. J Urol. 2012 Dec;188(6 Suppl):2473-2481. google scholar
  • 10. Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. Am Fam Physician. 2013 Dec 1;88(11):747-754. google scholar
  • 11. Feldman AS, Hsu CY, Kurtz M, Cho KC. Etiology and evaluation of hematuria in adults. Wolters Kluwer Health, 2013. www.uptodate.com/contents/etiology-and-evaluation-of-hematuria-in-adults (last accessed on 01 Oct 2022). google scholar
  • 12. Köhler H, Wandel E, Brunck B. Acanthocyturia—a characteristic marker for glomerular bleeding. Kidney Int. 1991 Jul;40(1):115-120. google scholar
  • 13. Linder BJ, Bass EJ, Mostafid H, Boorjian SA. Guideline of guidelines: asymptomatic microscopic haema-turia. BJU Int. 2018 Feb;121(2):176-183. google scholar
  • 14. Mazhari R., Kimmel PL. Hematuria: an algorithmic approach to finding the cause. Cleve Clin J Med. 2002 Nov;69(11):870-884. google scholar
  • 15. Willis GC, Tewelde SZ. The approach to the patient with hematuria. Emerg Med Clin North Am. 2019 Nov;37(4):755-769. google scholar
  • 16. Gow JG. Genitourinary tuberculosis. In Suki and Massry’s Therapy of Renal Diseases and Related Disor-ders (pp. 451-458). Springer, Boston, MA. google scholar
  • 17. https://hsgm.saglik.gov.tr/depo/birimler/tuberkuloz_db/dosya/Istatistikler/Yeni/Tuberkuloz_Olgularinin_ Dogdugu_Ulkeye_Gore_Dagilimi.pdf. google scholar
  • 18. Kamat AM, Hahn NM, Efstathiou JA, et al. Bladder cancer. Lancet. 2016;388:2796-2810. google scholar
  • 19. Khadra MH, Pickard RS, Charlton M, Powell PH, Neal DE. A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. J Urol. 2000 Feb;163(2):524-527. google scholar
  • 20. Jung H, Gleason, JM., Loo RK, Patel HS, Slezak JM, Jacobsen SJ. Association of hematuria on microsco-pic urinalysis and risk of urinary tract cancer. J Urol. 2011 May;185(5):1698-1703. google scholar
  • 21. Nielsen M, Qaseem A, High Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physici-ans. Ann Intern Med. 2016 Apr 5;164(7):488-497. google scholar
  • 22. Wang Z, Vathsala A, Tiong HY. Haematuria in postrenal transplant patients. Biomed Res Int. 2015;2015:292034. google scholar
  • 23. Moreno JA, Sevillano Â, Gutierrez E, et al. Glomerular hematuria: cause or consequence of renal inflam-mation? Int J Mol Sci. 2019 May 5;20(9):2205. google scholar
  • 24. Sevillano AM, Diaz M, Caravaca-Fontan F, et al. IgA nephropathy in elderly patients. Clin J Am Soc Nephrol. 2019 Aug 7;14(8):1183-1192. google scholar
  • 25. Isolated hematuria and sterile pyuria may indicate systemic lupus erythematosus activity. J Rheumatol. 2015 Mar;42(3):437-440. google scholar
  • 26. Rhee RL, Davis JC, Ding L, et al. The utility of urinalysis in determining the risk of renal relapse in AN-CA-associated vasculitis. Clin J Am Soc Nephrol. 2018 Feb 7;13(2):251-257. google scholar
  • 27. Avellino GJ, Bose S, Wang DS. Diagnosis and management of hematuria. Surg Clin North Am. 2016 Jun;96(3):503-515. google scholar
  • 28. Haldar S, Dru C, Bhowmick NA. Mechanisms of hemorrhagic cystitis. Am J Clin Exp Urol. 2014 Oct 2;2(3):199-208. google scholar
  • 29. Goucher G, Saad F, Lukka H, Kapoor A. Canadian Urological Association Best Practice Report: Diagnosis and management of radiation-induced hemorrhagic cystitis. Can Urol Assoc J. 2019 Feb;13(2):15-23. google scholar
  • 30. Moudi E, Hosseini SR., Bijani, A. Higher rate of microscopic hematuria in elderly patients who take regular doses of aspirin: Result from AHAP Study. Caspian J Intern Med. 2016 Fall;7(4):278-282. google scholar
  • 31. Keskar V, McArthur E, Wald R, et al. The association of anticoagulation, ischemic stroke, and hemorrhage in elderly adults with chronic kidney disease and atrial fibrillation. Kidney Int. 2017 Apr;91(4):928-936. google scholar
  • 32. Choong SK, Walkden M., Kirby R. The management of intractable haematuria. BJU Int. 2000 Dec;86(9):951-959. google scholar
  • 33. Gonzalez AN, Lipsky MJ, Li, G, et al. The prevalence of bladder cancer during cystoscopy for asympto-matic microscopic hematuria. Urology. 2019 Apr;126:34-38. google scholar
  • 34. Parker AS, Arnold ML, Diehl ND, Hassan L, Thiel DD. Evaluation of awareness of risk factors for kidney cancer among patients presenting to a urology clinic. Scand J Urol. 2014 Jun;48(3): 239-244. google scholar
  • 35. Burger M, Catto JW, Dalbagni G, et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol. 2013 Feb;63(2):234-241. google scholar
  • 36. Rule AD, Bailey KR, Schwartz, GL, Khosla S, Lieske JC, Melton LJ 3rd. For estimating creatinine cle-arance measuring muscle mass gives better results than those based on demographics. Kidney Int. 2009 May;75(10):1071-1078. google scholar
  • 37. Gray Sears CL, Ward JF, Sears TS, Puckett MF, Kane CJ, Amling CL. Prospective comparison of compu-terized tomography and excretory urography in the initial evaluation of asymptomatic microhematuria. J Urol. 2002 Dec;168(6):2457-2460. google scholar
  • 38. Wiginton CD, Kelly B, Oto A, et al. Gadolinium-based contrast exposure, nephrogenic systemic fibrosis, and gadolinium detection in tissue. Am J Roentgenol. 2008 Apr;190(4):1060-1068. google scholar
  • 39. van der Molen AJ, Hovius MC. Hematuria: a problem-based imaging algorithm illustrating the recent Dutch guidelines on hematuria. AJR Am J Roentgenol. 2012 Jun;198(6):1256-1265. google scholar
  • 40. Verdejo C, Mendez S, Salinas J. Urinary tract dysfunction in older patients. Med Clin (Barc). 2016 Nov 18;147(10):455-460. google scholar
  • 41. Wallis CJD, Sayyid RK, Manyevitch R, et al. Diagnostic utility of axial imaging in the evaluation of hema-turia: a systematic review and critical appraisal of the literature. Can Urol Assoc J. 2021 Feb;15(2):48-55. google scholar


PAYLAŞ




İstanbul Üniversitesi Yayınları, uluslararası yayıncılık standartları ve etiğine uygun olarak, yüksek kalitede bilimsel dergi ve kitapların yayınlanmasıyla giderek artan bilimsel bilginin yayılmasına katkıda bulunmayı amaçlamaktadır. İstanbul Üniversitesi Yayınları açık erişimli, ticari olmayan, bilimsel yayıncılığı takip etmektedir.