Hematuria (American English) or haematuria (British English) is a clinical sign. It is defined by the presence of blood or red blood cells in the urine. An anatomical framework is helpful in developing a comprehensive differential diagnosis. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. These include the urinary system, female reproductive system, and integumentary system.
Urinary causes occur anywhere between the kidney glomerulus and the urethral meatus. These can be divided into glomerular and non-glomerular causes. Non-glomerular causes can be further subdivided into upper urinary tract and lower urinary tract causes. After conducting a thorough history and physical examination, further medical testing is warranted.
Patients can be stratified into high and low risk. High risk patients include those with visible hematuria or those with non-visible hematuria and risk factors. A complete evaluation of the urinary tract is indicated for hematuria. This includes imaging of the upper urinary tract and cystoscopy of the lower urinary tract.
Differential Diagnosis (Causes):
Urinary causes occur anywhere between the kidney glomerulus and the urethral meatus. These can be divided into glomerular and non-glomerular causes. Non-glomerular causes can be further subdivided into upper urinary tract and lower urinary tract causes. In general, nephrologists are the experts of glomerular hematuria while urologists manage non-glomerular hematuria. The differential diagnosis can be furthered refined by the temporality of hematuria and associated symptoms. Microscopic hematuria has a prevalence of 2-31%
- Glomerular hematuria
- Non-glomerular hematuria
- The differential diagnosis can be furthered refined by the temporality of hematuria and associated symptoms.
- During urination, blood can appear in the urine at the onset, midstream, or later.
- It can also have associated symptoms. These include nausea, fever, chills, abdominal pain, flank pain, groin pain, urinary frequency, urinary urgency, and pain or discomfort with urination.
- When hematuria becomes visible during urination can suggest where in the urinary tract the bleeding originates.
- The presence of hematuria without accompanying symptoms should be considered a tumor of the urinary tract until proven otherwise.
- Costo vertebral angle tenderness suggests upper urinary tract obstruction. A urinary stone is suggested by the presence of renal colic. The presence of a fever suggests pyelonephritis.
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