From the Guidelines
Patients with renal or genitourinary (GU) issues should be immediately alerted to seek medical attention if they experience new or worsening symptoms such as urinary incontinence, frequent urinary tract infections (UTIs), hematuria, or difficulties with catheterization, as these can be signs of underlying complications like bladder cancer, urinary lithiasis, or upper tract damage 1. These red flags are crucial for patients to recognize, especially those with neurogenic lower urinary tract dysfunction (NLUTD), as they can indicate serious conditions that require prompt evaluation and treatment.
- Key symptoms to watch out for include:
- New or worsening urinary incontinence
- Frequent UTIs or infections associated with fever or flank pain
- Hematuria, even with catheterization
- Difficulties with catheterization
- New upper tract findings such as stones or hydronephrosis/vesicoureteral reflux (VUR)
- It is essential for patients to understand that these symptoms can be early signs of serious conditions, such as bladder cancer, which is more common in patients with NLUTD, with gross hematuria being the most common presenting symptom, occurring in 32% of cases 1.
- Patients should be educated on the importance of reporting these symptoms to their clinician, as they can indicate the need for further evaluation, such as a hematuria workup, to prevent long-term complications and ensure timely intervention.
From the Research
Renal/GU Red Flags
The following are renal/Genitourinary (GU) red flags that patients should be alerted about:
- Severe pain, especially flank pain or groin pain, which can be a symptom of kidney stones 2
- Fever, which can indicate an infection such as pyelonephritis or urosepsis 3, 4
- Hematuria, or blood in the urine, which can be a sign of kidney stones, infection, or other GU problems 2
- Dysuria, or painful urination, which can be a symptom of a urinary tract infection (UTI) 2
- Urinary frequency or urgency, which can be a sign of a UTI or other GU issue 2
- Sepsis, which can occur as a result of an untreated infection and can be life-threatening 5, 4
- Obstructive pyelonephritis, which is a urologic emergency that can result in sepsis and even death if left untreated 3
High-Risk Patients
Certain patients are at higher risk for renal/GU red flags, including:
- Those with a history of kidney stones or UTIs 2, 4
- Patients with anatomical abnormalities of the urinary tract 2, 4
- Individuals with certain medical conditions, such as diabetes or metabolic syndrome 2
- Patients who are immunocompromised or have a high Charlson comorbidity index 4, 6
- Elderly patients or those with a high body mass index (BMI) 6
Prevention and Treatment
To prevent and treat renal/GU red flags, patients should: