Q:

Which of the following is NOT a true cause of haematuria?

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Which of the following is NOT a true cause of haematuria?


  1. Glomerulonephritis.
  2. Ureteric stone.
  3. Schistosomiasis.
  4. Rifampicin.
  5. Malaria.

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d. Rifampicin is known for causing a reddish/orange discolouration to the urine among other non-therapeutic effects that include liver enzyme induction and resistance when used not in combination with other anti-tuberculous medications. These effects are helpfully summed up by ‘the three R’s of Rifampicin’ (Revs up liver enzymes, Red/orange discolouration and Resistance when used alone). True causes of haematuria are best described anatomically from the kidney downwards and include glomerulonephritic processes, polycystic kidney disease, trauma and urinary tract stone. Infectious processes include TB, cystitis of the bladder and schistosomiasis (especially if the patient has a positive travel history) and prostatic carcinoma, urethral trauma, urethritis or neoplasm. General causes of abnormal coagulation must always be excluded in any case of bleeding and inherited bleeding disorders such as haemophilia and any derangement in coagulation profile must be excluded. Malaria can cause haematuria and a full history of recent travel must be elicited. Investigation of this often benign but occasionally life-threatening parasitic disease must be undertaken swiftly but should not delay empirical treatment if laboratory turn around times of thick and thin films looking for malarial parasites is slow. Treatment of Plasmodium falciparum malaria is of vital importance due to the association with cerebral malaria and should depend on local sensitivities to anti-malarial drugs; however, a week’s course of quinine followed by fansidar (with glucose-6-phosphatase deficiency, G6PD, investigation) is usually an adequate treatment regime. G6PD deficiency poses a risk of haemolytic anaemia with certain medications notably antimalarials and G6PD status is usually taken as soon as possible to but not delaying the start of treatment.

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