On 24/08/07, Julian Bradley <[log in to unmask]> wrote:
Depending on your point of view ask the patient if they have any
local lesion or examine the patient in detail for any local lesion -
our urologists are particularly fussed about this after 1 patient in
20 yrs was referred for cystoscopy but had a penile tumour (not a
patient I or my practice had any contact with, but I felt quite
supportive of the GP concerned).
but still surely a urological problem so an appropriate referral
I recollect reading some years ago that some kind of stereo
microscopy could be used to differentiate renal and LUT blood loss,
but I've asked about this a few times since and no-one locally has
taken it up or thought it worth pursuing, and never got high enough
on my priority list to find out more.
this was what i meant by red cell morpholgy - easy to ask for in Australia anyway although sometimes the labs state insufficient red cells to make the judgement. the local nephrologist however will often look at the urine himself in these circumstances to make this call and is inclined not to go for cystoscopy if he can convinve himself that the red cells are small in number and derived from the kidney.
insurance medicals are often a problem - i had a patient with a mildly raised ferretin that contibuted to a higher premium but was extremely difficult to attribute to any significant pathology after a round of follow up tests etc.
Adrian
(Mount Gambier, S Australia)
