Type II Cryoglobulinaemia causing Monoclonal Gammopathy of Renal Significance

A 53 year old female with a background of hypertension, hypothyroidism and Raynaud’s was admitted with an acute ischaemic stroke and referred to the renal team after a routine urine dip revealed microscopic haematuria and nephrotic-range proteinuria. Blood tests revealed renal impairment, a monoclonal IgM kappa paraprotein, low complement C4 concentration and a positive rheumatoid factor. Active cryoglobulinaemia was suspected and testing demonstrated type II cryoglobulins secondary to the monoclonal IgM kappa paraprotein. Bone marrow biopsy was normal. Renal biopsy revealed cryoglobulinaemia associated membranoproliferative glomerulonephritis. Treatment with steroids and rituximab improved renal function and proteinuria. This case fits within the evolving spectrum of disorders now termed Monoclonal Gammopathy of Renal Significance and highlights the value of biopsying and treating these patients early.

Retro-Aortic Left Renal Vein as an Uncommon Cause of Left Sided Varicocele and Haematuria.

Retro-aortic left renal vein [RLRV] is a congenital anomaly characterised by a left renal vein passing posterior to abdominal aorta. It has been suggested that RLRV may cause varicocele and haematuria. The urological symptoms are probably due to the increased pressure in the left renal vein secondary to posterior nutcracker phenomenon. The diagnosis of RLRV is usually radiological. We report a case of a 53-year old man who presented with left scrotal swelling which was then confirmed to be varicocele by Doppler ultrasound. Two months later, the patient had microscopic haematuria and computed tomography [CT] abdomen and pelvis scan was done. CT showed presence of RLRV. Keywords: Retro-aortic left renal vein; varicocele; haematuria; computed tomography [CT].

Haematuria in children

Haematuria in children can be associated with many illnesses, from the benign and self-limiting to the more complex and life-threatening. The most common form of haematuria in children is microscopic haematuria. Visible blood (also termed frank haematuria) is an uncommon, but often very distressing, finding for child and parent. Although the majority of cases are benign or less serious, it is important to identify those patients requiring referral to secondary care for further investigation and management. It is equally important to identify patients for diagnosis and appropriate management in primary care.

Streamlined haematuria pathway: Reduced waiting times and improved cost benefits

Objectives: Haematuria is a common urological complaint that carries a significant burden to our healthcare system. Due to the complex investigation algorithm for haematuria, incomplete referrals result in multiple appointments. We established the “streamlined haematuria pathway” (SHP) phone clinic, and this study evaluated the effect of SHP on waiting times, patient care and time to treatment. Methods: A retrospective analysis of all patients who were reviewed via our SHP was performed, including time to see and outcomes. The effects of implementing the SHP on our health system were assessed by analysing our referral waitlists and costings department. Results: On starting the SHP phone clinic there were 1031 referrals waiting longer than clinical recommended time frames, and of these 92 were identified as a patient with haematuria. The majority of patients were male sex (55%), had microscopic haematuria (63%), and the median age was 69 years. There were 12 (30%) patients who were waiting 100 days or more before the phone clinic was introduced. A total of 87% patients were discharged post-normal outcomes, 5% patients had stones and 8% patients were diagnosed with bladder malignancy. Conclusions: The SHP phone clinic is an effort to decrease morbidity and mortality by earlier diagnosis of urological malignancy. Level of evidence: 3-b

Heparin-induced gross haematuria : a case study

Spotting blood in urine can be alarming. In many instances the cause is harmless, but blood in urine can indicate a serious disorder. Haematuria can be categorized into two categories, such as gross haematuria and microscopic haematuria. Gross haematuria is visible with naked eyes, and easily identifiable, whereas microscopic haematuria can be identified after doing a urine test under a microscope. It is important to know the primary cause of bleeding. It can be either due to medications, kidney disorders, urinary tract infections or strenuous exercise's. Here we report a case series of gross haematuria for three patients where it has been caused by anticoagulant drug heparin. Our case series illustrates a strong causal relation with heparin causing gross haematuria.