American Board of Internal Medicine (ABIM) Certification Practice Exam

What is one of the first steps in managing a patient with suspected glomerular hematuria?

1. Immediate nephrectomy

2. Urine sediment examination

3. Radiology imaging

4. Chemotherapy

The correct answer is: Urine sediment examination

In managing a patient with suspected glomerular hematuria, one of the first steps is conducting a urine sediment examination. This test allows clinicians to analyze the urine's components and helps identify the presence of red blood cells, the formation of casts, or other abnormalities that may indicate glomerular involvement. Specifically, glomerular hematuria typically features dysmorphic red blood cells and red blood cell casts, which suggest that the bleeding is originating from the glomeruli rather than from the urinary tract. The urine sediment examination is crucial for establishing the diagnosis and guiding further workup and treatment. It is a non-invasive and straightforward procedure that can provide immediate insights into the underlying pathology. Consequently, it plays a pivotal role in the early assessment of kidney-related issues that manifest as hematuria. The other steps mentioned, such as immediate nephrectomy, radiology imaging, and chemotherapy, are not appropriate initial actions in the context of suspected glomerular hematuria and typically follow after further diagnostic steps or based on specific clinical scenarios.