In many patients, particularly young adult patients, the hematuria is transient and of no consequence. In the differential diagnostics a distinction is made between painful and painfree and between macrohematuria which is visible to the naked eye and microhematuria which is not visible. Gross hematuria is defined as readily visible and microscopic hematuria as 5 rbchpf. An algorithm for the evaluation of essential hematuria. In terms of nonrenal causes, the most common culprits are drugs, fever, coagulopathy, exercise, or menses. Some authors recommend that 2 of 3 urinalyses show microhematuria before an evaluation is undertaken. The differential diagnosis of hematuria is often divided into microscopic hematuria or macroscopic hematuria. Racgp macroscopic haematuria a urological approach. The reasons for hematuria are basically renal glomerular and nonrenal nonglomerular causes. For purposes of the ensuing discussion, it is assumed that the diagnosis of true gross or microscopic hematuria has already been established. Brown urine with rbc casts and proteinuria suggests glomerular source. Hematuria is the main symptom of many urological and nephrological diseases. Hematuria may be visible to the naked eye called gross hematuria or detectable only on examination of the urine sediment by microscopy called microscopic hematuria.
An algorithmic approach to finding the cause cleveland clinic journal of medicine. Differential diagnosis of glomerulonephritis poststreptococcal acute glomerulonephritis iga nephropathies iga nephropathy bergers disease henochsch onlein membranoproliferative glomerulonephritis idiopathictypes i, ii, iii secondarynephritis of chronic bacteremia, hepatitis b and c, alpha1 antitrypsin deficiency, etc. Mar 10, 2016 conversely, 40% of patients with gross hematuria have no diagnosis made. The color change does not necessarily reflect the degree of blood loss, since as little as 1 ml of blood per liter of urine can induce a visible color change. An evidencebased approach to the management of hematuria in. Haematuria has a wide range of differential diagnosis extending from urinary tract infection to carcinoma 6. Understand the common causes of proteinuria and hematuria and be able to differentiate between benign and serious causes. Causes of hematuria in children glomerular diseases recurrent gross hematuria iga. The differential diagnosis includes though not limited to 4. Things that would give you a clue as to what might have caused the hematuria. Differential diagnosis of red urine it does not always need to be blood o haematuria red blood cells in urine macroscopic or microscopic o haemoglobinuria from haemolysis. Urinalysis can exclude the presence of myoglobinuria and rhabdomyolysis, which can mimic hematuria. May 10, 2020 generally, hematuria is defined as the presence of 5 or more red blood cells rbcs per highpower field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart.
Macroscopic hematuria requires prompt eval uation to exclude potentially lifethreatening causes. We then discuss the evaluation and differential diagnosis of hematuria, including unusual urologic causes and the more common nonurologic causes of. Rhabdomyolysis can be provoked during strenuous exercise and dehydration and may also occur during severe sickle cell crises. Because of its high prevalence and because of the differential diagnoses, amh.
Gross hematuria gross hematuria is suspected because of the presence of red or brown urine. Differential diagnosis and management of macrohematuria. Proteinuria differential diagnosis of hematuria microscopic hematuria in 5 patients. In contrast to painless hematuria in adults, the differential diagnosis and investigative modalities in the pediatric. Nov 01, 2002 many conditions can cause hematuria, but the differential diagnosis can be simplified with a systematic approach. Distinguish between isolated hematuria and hematuria associated with other renal and systemic manifestations that would require nephrology follow up. Hematuria can be from prerenal causes when vascular damage occurs, such as trauma to the kidney, septicemia, and purpura hemorrhagica. Evaluation and differential diagnosis in adults american.
Macroscopic hematuria is red or brown urine, sometimes with blood clots. Dysuria, frequency, or urgency suggests urinary tract infection uti. Visible hematuria, even when transient or asymptomatic, may indicate a significant disease process and always requires further investigation. Renal causes include acute glomerulonephritis, renal infarction, embolism of the renal artery, tubular damage from toxic insult, and pyelonephritis. Although the prevalence of serious disease eg, malignancy is higher in patients with gross hematuria, microscopic hematuria may also indicate significant genitourinary pathology. Haematuria is the presence of blood in the urine, either visible seen by the naked eye or nonvisible confirmed by urine dipstick or urine microscopy it is never a normal finding and has a range of urological and nonurological causes, both malignant and.
In this chapter we provide an overview of hematuria and discuss important aspects of the history and physical examination. Although the differential diagnosis for hematuria is extensive, most cases are isolated and benign. An evidencebased approach to differential diagnosis, 2e. Unilateral flank pain that may radiate to the groin suggests nephrololithiasis. Haematuria painless visible diagnostic imaging pathways. Differential diagnosis having an organized differential diagnosis is very important. Evaluation of visible hematuria differential diagnosis of. A differential diagnosis that encompasses glomerular disease, infections. This article will discuss the differential diagnosis of haematuria from a urological perspective, important investigations. Proteinuria diagnosis of hematuria microscopic hematuria in 165 patients with no other renal or systemic findings. Apr 11, 2021 hematuria is an abnormal number of red blood cells rbcs in urine and is the chief complaint for 0.
Positive urine dipstick when urine spun in centrifuge the entire fluid will remain red whereas whole red blood. Rare causes of hematuria associated with various vascular. Hematuria can be either gross ie, overtly bloody, smoky, or teacolored urine or microscopic. Underlying causes of hematuria range from iatrogenic sources such as sample collection technique to disorders that produce marked morbidity.
Hematuria defined as rbc 25 cells under hpf can be detected by dipstick false positive. Evaluate the source of hematuria based on history, physical exam, and diagnostic studies. Hematuria defined as rbc 25 cells under hpf can be detected by dipstick. Asymptomatic hematuria is very common in pediatric and adolescent patients. We then discuss the evaluation and differential diagnosis of hematuria, including unusual urologic causes and the more common nonurologic causes of hematuria. Azotemia may implicate the kidney as a source of hematuria and complicate diagnosis and treatment, especially if anesthesia or other procedures that could compromise kidney function are required. As little as 1 ml of blood can impart color to 1 liter of urine. Identify the different causes of hematuria in children. Pdf evaluation and management of hematuria researchgate. Differential diagnosis of red urine it does not always need to be blood o haematuria.
Refined microscopic urinalysis for red blood cell morphology in the evaluation of asymptomatic microscopic hematuria in a pediatric population. Among the causes of hematuria, vascular disease is extremely rare. Haematuria is the presence of blood in the urine, either visible seen by the naked eye or nonvisible confirmed by urine dipstick or urine microscopy it is never a normal finding and has a range of urological and nonurological causes, both malignant and benign, which commonly require further investigation. Frequently you start with inquiring about things that might give you hematuria of a nonspecific nature, such as fever, abdominal pain, dysuria. This makes the differential diagnosis extensive and seemingly disjointed. Assessment of asymptomatic microscopic hematuria in adults. An algorithmic approach to finding the cause many conditions can cause hematuria, but the differential diagnosis can be simplified with a systematic approach. Recognize the criteria for diagnosis of proteinuria and hematuria. Differential diagnosis of hematuria r2 vs 20200109. Hematuria is a common finding in children and often comes to the attention of the pediatrician as a result of a routine screening urinalysis, as an incidental finding when evaluating urinary tract symptoms, or when a child has gross hematuria. Hematuria is the presence of gross or microscopic blood in the urine.
While the causes of hematuria are extensive, the most common differential diagnosis for both microscopic and gross hematuria in adults includes infection, malignancy, and. An anatomical framework is helpful in developing a comprehensive differential diagnosis. In patients with suspected microscopic hematuria, urine dip stick testing may. In contrast to painless hematuria in adults, the differential diagnosis and investigative modalities in the pediatric population is vastly different. The color change does not necessarily reflect the degree of blood loss, since as little as 1 ml of blood per. It may also be either symptomatic or asymptomatic, either transient or persistent, and either isolated or associated with proteinuria and other urinary abnormalities. Hematuria and leukocyturia were more frequent during the initial observation period. Differential diagnosis of glomerulonephritis poststreptococcal acute glomerulonephritis iga nephropathies iga nephropathy bergers disease henochsch onlein. Hematuria remains one of the most common urologic diagnoses, estimated to account for over 20% of urology evaluations.
Visible gross hematuria is urine that is visibly discolored by blood or blood clot. Rapid and accurate evaluation and diagnosis may prevent serious complications. A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. Dec 01, 20 in 2012, the american urological association aua published an updated guideline on the diagnosis, evaluation, and followup of asymptomatic microscopic hematuria in adults. It may present as urine that is red to brown, or as frank blood. Any condition that causes hematuria with clots can cause dysuria, including renal neoplasms and nephrolithiasis. Imaging tests should be conducted in all boys of any age with first uti, in girls younger than 5 years. It is a common symptom of both benign and malignant conditions. In anttilas study of 165 children, transient microscopic hematuria was observed in 23%, leukocyturia in 25%, and lowgrade proteinuria in 42%. Evaluation and differential diagnosis of hematuria springerlink. The differential diagnosis includes renal, ureteral, bladder, and urethral injury. Evaluation of visible hematuria differentials bmj best. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. This article will discuss the differential diagnosis of haematuria from a urological perspective, important investigations to determine the cause, and resultant management.
With hematuria, it is easiest to classify the etiologies as nonrenal, lower tract, glomerular and nonglomerular. It may be grossly visible macroscopic or detectable only on urine examination called microscopic. Visible hematuria, even when transient or asymptomatic, may indicate a significan. Uti should be part of differential diagnoses in any febrile infant or child. Because urological cancer is more common in males, those men over 50 who present with hematuria should have a complete and thorough evaluation of the urinary. Extensive ddx o bladderkidneyprostate cancer o bph o nephrolithiasis o endometriosis o intrinsic glomerular disease o polycystic kidney disease.
Common urological causes of haematuria include urinary tract infection. Evaluation of visible hematuria differential diagnosis. Etiology and evaluation of hematuria in adults uptodate. Microscopic hematuria tends to occur with kidney disease. Extensive ddx o bladderkidneyprostate cancer o bph o nephrolithiasis o endometriosis o intrinsic glomerular disease. Evaluation of hematuria osu center for continuing medical. Microscopic hematuria is present when microscopic inspection of at least 2 properly collected urine specimens show 3 rbcs per highpowered field hpf. Hematuria differential diagnosis usmle step 2 cs mnemonics. Differential diagnosis of hematuria microscopic hematuria in 5 patients. A diagnosis of hematuria is confirmed by demonstration of red blood cells in the. We discuss the common causes of hematuria and how to evaluate it.
Pathologic diagnosis % of patients none 53 but %no em igan 30 thin gbm 4 mesangial proliferation 7 fsgs 3 htn, membranous, int nephritis 3 topham et al, q. Evaluation and differential diagnosis of hematuria. Describe screening techniques for initial evaluation of hematuria and proteinuria. Urinalysis is an essential part of evaluating hematuria, regardless of the source. Hematuria that is not explained by an obvious underlying condition. These include the urinary system, female reproductive system, and integumentary. Many conditions can cause hematuria, but the differential diagnosis can be simplified with a systematic approach.
Unless the symptoms are strongly suggestive, the diagnosis of gross hematuria, or visible blood in the urine, must be. Haematuria is defined as evidence of blood in the urine under microscopy. Nevertheless, an orderly, comprehensive approach can greatly simplify the diagnosis. Postrenal hematuria occurs particularly in urolithiasis and cystitis. This article presents the major diseases that may cause hematuria in children and suggests an evaluation algorithm for. Red blood cells in urine macroscopic or microscopic.
Asymptomatic microscopic hematuria is an important clinical sign of. An evidencebased approach to the management of hematuria. The urinalysis in nonglomerular medical and surgical hematuria is similar in that both are characterized by circular erythrocytes and the absence of erythrocyte casts 12. Nonspecific symptoms such as fatigue and lethargy are common. Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. Key ddx o myoglobinuria caused by rhabdomyolysis o march hemoglobinuria o uti 2. Mar 15, 2005 patients with microscopic hematuria i.
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