A Mail Carrier With Gross Hematuria Whose Sister Has Lupus

Paige A. Hargis, BS; Katie S. Murray, DO, MS

Disclosures

October 12, 2021

Physical Examination and Workup

Upon physical examination, the patient appears well. His temperature is 98.5 °F (36.9 °C), his blood pressure is 134/89 mm Hg, his heart rate is 76 beats/min, and his respiration rate is 14 breaths/min. Pulse oximetry shows an oxygen saturation of 99% on room air. The lungs are clear to auscultation, and breath sounds are equal. Results of the cardiac examination are unremarkable. No tenderness to palpation of the abdomen or pelvis is noted. Flank tenderness is not appreciated. Capillary refill time is < 2 seconds. Some bruising is observed on the upper extremities, but the rest of the examination reveals no obvious signs of bleeding.

Laboratory studies show the following values:

  • White blood cell (WBC) count: 9.07 × 109 cells/L (reference range, 4-11 × 109 cells/L)

  • Hemoglobin level: 12.0 g/dL (reference range, 13.5-15.5 g/dL)

  • Hematocrit: 41.3% (reference range, 45%-52%)

  • Platelet count: 304 × 109 cells/L (reference range, 150-400 × 109 cells/L)

  • Glucose level: 106 mg/dL (reference range, <160 mg/dL)

  • Blood urea nitrogen: 18 mg/dL (reference range, 8-24 mg/dL)

  • Creatinine level: 1.04 mg/dL (reference range, 0.9-1.3 mg/dL)

  • International normalized ratio (INR): 3.2 (reference range, 2-3)

Urinalysis findings are as follows:

  • Grossly bloody urine

  • Red blood cell (RBC) count: > 30 RBCs per high-power field (HPF) (reference range, ≤ 2 RBCs/HPF)

  • WBC count: 20-50 WBCs/HPF (reference range, ≤ 2-5 WBCs/HPF)

  • Leukocyte esterase and nitrites: Negative

  • Few epithelial cells

  • No bacteria

The patient's anticoagulation regimen is adjusted, and subsequent ultrasound does not show any masses, hydronephrosis, or stones.

The patient is referred to a urologist for further evaluation and workup. Two weeks after the initial urology visit, cystoscopy is performed. The findings resemble those shown below in a different patient (Figure 1).

Figure 1.

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