What is significant hematuria for the primary care physician?

Hematuria is a common finding in primary care practice. Causes of significant hematuria include urinary tract infection, urolithiasis, malignancies, benign prostatic hyperplasia, and nephropathies. Hematuria is identified by taking a patient history and by performing a routine urine dipstick test. If a patient has a history of gross hematuria and/or a positive urine dipstick test, he or she should then have a microscopic urinalysis. The primary care physician can order ancillary tests such as laboratory tests to assess renal function, and possible imaging tests such as ultrasound, computed tomography urography, or magnetic resonance urography. The patient may be referred to a nephrologist or urologist for further assessment if required. Cystoscopy may be considered. Even if the patient has a negative work up, guidelines recommend that primary care physicians follow the patient semi-annually for 3 years.

Inferior vena cavectomy for renal cell carcinoma with intracaval tumor thrombus.

Excision of the inferior vena cava for renal cell carcinoma with intracaval tumor thrombus is infrequently performed. Herein the authors report a 60-year old woman with a right renal cell carcinoma and massive occluding tumor thrombus of the inferior vena cava. Following a negative metastatic workup, this patient underwent surgery to remove the tumor and thrombus. Thrombectomy occurred via excision of the affected portion of inferior vena cava and proximal left renal vein. Reconstruction of the vena cava was not undertaken. The patient did not suffer any morbidity during recovery in hospital. Her renal function was normal upon discharge. All resection margins were negative for tumor. This experience is compared to those reported in the literature. Postoperative morbidity may be minimized by careful patient selection. Suitable patients should have a right-sided tumor with an occlusive subhepatic vena caval tumor thrombus.