Hematuria
Vanessa Cardy, MD, and Heidi James, MD
Background
- Gross hematuria
- Blood in the urine that is visible to naked eye
- Urine is brown or red tinged
- Microscopic hematuria
- 3 or more red blood cells (RBCs)/high-power field (hpf) seen with microscope
- Should be present on >1 sample
- Etiologies
- Non-glomerular and extra-renal
- Cancer, stones, trauma
- Infections, bleeding disorders, endometriosis
- Benign prostatic hyperplasia
- Non-glomerular and intra-renal
- Cancers
- Infections (tuberculosis, pyelonephritis)
- Vascular diseases (arteriovenous malformation, renal vein thrombosis)
- Glomerular causes
- Causes of nephritic syndromes
- Includes autoimmune disease
- see Glomerulonephritis chapter
- Medications
- Nitrofurantoin, methyldopa
Clinical Findings
- Symptoms/Signs
- Look for neoplasm red flags
- Dysuria, frequency, urgency, nausea, and vomiting
- History of recent URTI possible in autoimmune cases
- Investigations
- Gross hematuria
- Urinalysis and culture
- Complete blood count (CBC), renal function, coagulation studies
- Imaging for stones, neoplasms
- Microscopic hematuria
- Urinalysis and urine
- CBC, renal function, coagulation studies
- Renal ultrasound
- Urine cytology
- Determine if blood is of glomerular or extra-glomerular source
Management
- Consult urology and nephrology as needed
- If no clear etiology identified, repeat investigations may be needed
