Pdf causes of hematuria can range from benign conditions such as urinary tract. In many patients, particularly young adult patients, the hematuria is transient and of no consequence. Asymptomatic proteinuria and hematuria syndrome is the result of diseases of glomeruli clusters of microscopic blood vessels in the kidneys that have small pores through which blood is filtered. In addition, the evidence primarily is based on data from male patients. A kidney biopsy is often required to diagnose the underlying pathology in patients with suspected glomerular disease. Hematuria is caused by your kidneys allowing blood cells to leak into the urine. A large prospective study that analyzed the diagnostic yield of 4000 patients attending a hematuria clinic was published by edwards et al. Hematuria is termed gross, or macroscopic, when there is sufficient blood present to color the urine red or brown. Conversely, 40% of patients with gross hematuria have no diagnosis made. What is symptomatic hematuria and what diagnosis do certain symptoms suggest. Hematuria defined as rbc 25 cells under hpf can be detected by dipstick false positive.
However, whether the patient is a man or a woman influences the differential diagnosis of asymptomatic microscopic hematuria, and the risk of urinary tract malignancy bladder, ureter, and kidney is significantly less in women than in men. Atoz guide from diagnosis to treatment to prevention blood in the urine is called hematuria. Pdf evaluation and management of hematuria researchgate. 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. Further diagnostic separation within the diagnosis cluster is achieved by using the references provided herein, and those available from. If the blood is invisible and is discovered only when a urine sample is examined in a laboratory urine test urinalysis, the condition is called microscopic hematuria. An xray, ultrasound, or ct may show the cause of your hematuria.
Blood or red blood cells can enter and mix with urine at multiple anatomical sites. Of those with microscopic hematuria, 153 had urinary tract calculi. Medical history and urine analysis are cornerstones for planing rational further imaging and endoscopic diagnosis. In the absence of highquality scientific evidence, the recommendations of current guidelines for the diagnostic evaluation of hematuria are not uniform. Article in german horstmann m1, franiel t, grimm mo. Red blood cells in urine macroscopic or microscopic. If it is visible to the naked eye, it is called gross hematuria.
Key ddx o myoglobinuria caused by rhabdomyolysis o march hemoglobinuria o uti 2. It may be grossly visible macroscopic or detectable only on urine examination called microscopic. Some common causes of hematuria are bladder infection, kidney stone, trauma to the kidneys or bladder, and some medications. Hematuria may be an indication of a serious blood clotting or platelet disorder. Diagnostic tests and algorithms used in the investigation of haematuria. Bladder cancer differential diagnoses medscape reference. With repeated evaluations, the prevalence of asymptomatic microscopic hematuria decreases to less than 0. The algorithm for evaluating a child with microscopic hematuria is shown in figure 1.
Haematuria painless visible diagnostic imaging pathways. However, today most cancers are found serendipitously at the time of an abdominal ultrasound. Etiologies of asymptomatic microscopic hematuria in children. Visible hematuria, even when transient or asymptomatic, may indicate a significant disease process and always requires further investigation. If the clinical evaluation and urinalysis suggest a glomerular. Having blood in your urine doesnt always mean you have a medical problem. Microscopic hematuria is defined as the excretion of more than three red blood cells per highpower field in a centrifuged urine specimen. Key points even if a dipstick test for hematuria is positive, a key. 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. Diseases of the kidney and the urinary tract can present with a wide array of symptoms.
May 10, 2020 asymptomatic microscopic hematuria is, on average, 10fold as prevalent as gross hematuria 1. 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. The blood may be visible, so that the urine appears reddish or darker than normal. Hematuria is termed microscopic when the urine is visually normal in color but is found to contain blood on chemical analysis or microscopic evaluation. Differential diagnosis urolithiasis malignancy bladder cancer upper tract urothelial carcinoma renal cell carcinoma uti.
Initial exclusion of other differential diagnosis based on the absence of certain clinical symptoms and signs is reasonable. Postrenal hematuria occurs particularly in urolithiasis and. Therefore, acute abdominal pain requires consideration of the kidneys and urinary tract. Diagnosis and management of incidentally discovered microscopic hematuria figure 1. Bloody urine may be caused by abnormalities in the urinary tract or by disease processes elsewhere in the body that can affect the urinary tract. Diagnostic evaluation of the kidney and urinary tract. Algorithm for the diagnosis and management of incidentally discovered microscopic hematuria. The differential diagnosis includes though not limited to. The first episode occurred a few days after the onset of a uri. Because of its high prevalence and because of the differential diagnoses, amh. If there are no indications that require immediate intervention after a stepwise evaluation, the parents should be reassured that there are no lifethreatening problems, such as cancer, leukemia, or chronic kidney damage, and that most cases of isolated microhematuria in children do not warrant treatment. Haematuria differential diagnosis of red urine it does not always.
Hematuria has many causes, and a broad urological and nephrological differential diagnosis must be considered. Differential diagnosis, workup, and treatment leonidizikson,md,josephc. For purposes of the ensuing discussion, it is assumed that the diagnosis of true gross or microscopic hematuria has already been established. A detailed medical history is obtained to help ascertain the underlying cause. The role of imaging in the investigation of painless. The differential diagnosis includes renal, ureteral, bladder, and urethral injury. Both utis and bladder cancer cause hematuria, and bacteriuria occurs in about 50% of patients with squamous cell carcinoma scc. An anatomical framework is helpful in developing a comprehensive differential diagnosis. A segregation index combining phenotypic clinical characteristics and. The differential diagnosis of hematuria is often divided into microscopic hematuria or macroscopic hematuria. Assessment of asymptomatic microscopic hematuria in adults. In this chapter we provide an overview of hematuria and discuss important aspects of the history and physical examination. Differential diagnosis of hematuria anatomy renal cyst, avm, hydronephrosis boulders renal stone, hypercalciuria cancer wilms tumor, adenocarcinoma drugrelated cyclophosphamide exercise foreign body. On the other hand, there is an appreciable risk of malignancy in older patients eg, over age 35 years with hematuria, even if transient.
Hematuria is the condition of having blood in the urine. Diagnosis, evaluation and followup of asymptomatic microhematuria in adults. Hematuria defined as the presence of blood or red blood cells in the urine. Evaluation and differential diagnosis in adults thomas c. Differential diagnosis uti malignancy bladder cancer upper tract urothelial carcinoma renal cell carcinoma urolithiasis.
Frequently you start with inquiring about things that might give you hematuria of a nonspecific nature, such as fever, abdominal pain, dysuria. It may be due to injury to the kidneys, urinary tract, prostate, or genitals. Utis are usually associated with irritative voiding symptoms eg, dysuria, frequency, urgency. A stepwise approach to investigating hematuria in dogs. Patients with isolated glomerular hematuria are at elevated risk for renal. However, fewer rbcs from just 1 specimen should not. And, although it has many possible causes, the most common originate in the urinary tract and include calculi, tumors predominantly transitional cell carcinoma of the urinary bladder, and bacterial infection.
Although an uncommon occurrence in children, it is nevertheless a disturbing finding for both the affected child and hisher family. Extensive ddx o bladderkidneyprostate cancer o bph o nephrolithiasis o endometriosis o intrinsic glomerular disease o polycystic kidney disease. In many such patients, particularly young adult patients, the hematuria is transient and of no consequence 1. 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. Hematuria can be either gross ie, overtly bloody, smoky, or teacolored urine or microscopic. Hematuria adult urologic conditions and treatments. A wide differential diagnosis must be considered if hematuria persists longer than 24 to 72 hours. Proteinuria differential diagnosis of hematuria microscopic hematuria in 5 patients.
Hematuria is the presence of blood in a persons urine. Canadian guidelines for the management of asymptomatic. Differential diagnosis of hematuria microscopic hematuria in 5 patients. Feb 03, 2020 hematuria is blood in your urine from an injury or medical condition. The modern clinician can improve his diagnostic accuracy and therapy by proper integration with the laboratory.
A 3step diagnostic algorithm is proposed, starting from the evaluation of the severity of hematuria step 1, moving on to the differential diagnosis among the most common etiologies of hematuria based on patients history and examination step 2. Trauma to the kidney can occur from a direct blow or deceleration. Apr 24, 2019 the diagnosis of hematuria may involve multiple steps and a battery of tests, some of which are described below. The urinary tract is the bodys drainage system for removing wastes and extra fluid. Differential diagnosis of hematuria and microhematuria abnormal urine color. Differential diagnosis of hematuria r2 vs 20200109. Recognize that hypercalciuria can be symptomatic even in the absence of a kidney stone. Diagnostic yield in patients with microscopic and macroscopic hematuria.
Hematuria that is not explained by an obvious underlying condition eg, cystitis, ureteral stone is fairly common. Evaluation of visible hematuria differential diagnosis. Transient unexplained hematuria urinary tract infection urethritis benign prostatic hyperplasia stones urinary calculi menstruation contaminated urine exercise trauma atrophic vaginitis bladder cancer kidney cancer prostate cancer prostatitis radiation cystitis renal infarction. Mar 10, 2016 conversely, 40% of patients with gross hematuria have no diagnosis made. Urine sediment after centrifuge normally contains 2 to 3 rbcs per high power field rbchpf on microscopic exam.
Causes of hematuria in children glomerular diseases recurrent gross hematuria iga. Although the differential diagnosis for hematuria is extensive, most cases are isolated and benign. Pain, mass, and hematuria use to be considered the classic triad for the suspicion of renal cell cancer. Concomitant symptoms combining the risk factors, e. Hematuria is an important sign for the diagnosis of cancer of the urinary system. These include the urinary system, female reproductive system, and integumentary system. Sppd kgh content definition of hematuria etiology clinical feature differential diagnosis laboratory tests accompanied symptoms definition more than three red blood cells are found in centrifuged urine per highpower field microscopy 3 rbchp normal urine.
Renal causes include acute glomerulonephritis, renal infarction, embolism of the renal artery, tubular damage from toxic insult, and pyelonephritis. Incidence of hematuria with bph reported to be as high as 12% bph causing gross hematuria requiring transfusions. Rapid and accurate evaluation and diagnosis may prevent serious complications. Abdominal aortic aneurysm aaa, urogenital tract cancer, renal emboli from endocarditis, urethritis, benign prostatic hypertrophy, prostatitis, epididymitis, endometriosis, papillary necrosis, anticoagulation. Macroscopic hematuria is red or brown urine, sometimes with blood clots. Hematuria is an extremely common condition, and almost always requires a complete urologic evaluation. Greater than 2 rbcshpf on two microscopic urinalysis without recent exercise, menses, sexual activity or instrumentation grade c recommendation. Evaluation and differential diagnosis of hematuria springerlink. The urologist must have a thorough knowledge of the urologic causes of hematuria as well as the nonurologic causes. The presentation in bladder cancer may resemble urinary tract infection uti, or the 2 conditions may coexist.
Hematuria or blood in urine hematuria is blood in the urine. The potential etiologies of microscopic hematuria in children are myriad but mostly benign 3. Evaluation of asymptomatic microscopic hematuria in adults. Hematuria is the main symptom of many urological and nephrological diseases. Feb 03, 2020 blood and urine tests may show infection and how well your kidneys are working. It can be caused by a bleeding disorder or certain medications, or by stones, infection, or tumor. Things that would give you a clue as to what might have caused the hematuria. What is significant hematuria for the primary care physician. Algorithm 1 is a systematic and inclusive approach intended to narrow the differential diagnosis of glomerular disease to a single cluster of the most likely diagnoses, ranked in approximate incidence. Positive urine dipstick when urine spun in centrifuge the entire fluid will remain red whereas whole red blood. An algorithm for the evaluation of essential hematuria. In many patients, particularly young adult patients, the hematuria is transient and of no.
Haematuria 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. Hematuria differential diagnosis usmle step 2 cs mnemonics. Review the presentation and differential diagnosis of glomerular hematuria. Gross hematuria is defined by the presence of an increased number of red blood cells rbcs in the urine that is visible to the naked eye. Acute hematuria discharge care what you need to know. Most chronic renal diseases are asymptomatic and are only detected through abnormal findings. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Differential diagnosis of red urine it does not always need to be blood o haematuria. Include for each of the most common diagnoses what historical elements, clinical signs, and medical testing makes this diagnosis very likely. The purpose of this guideline is to provide a clinical framework for the diagnosis, evaluation, and followup of asymptomatic microhematuria amh. Although the prevalence of serious disease eg, malignancy is higher in patients with gross hematuria, microscopic hematuria may also indicate significant genitourinary pathology. On the other hand, there is an appreciable risk of malignancy in older patients eg, over age 35 years with. The differential diagnosis of acute and chronic glomerulonephritis includes a wide variety of organic renal and vascular diseases together with some of the functional causes of proteinuria. It is characterized by steady or intermittent loss of small amounts of protein and blood in the urine.
Abnormal urine color can simulate hematuria, microscopic examination of the urine shows no blood cells. Asymptomatic proteinuria and hematuria syndrome kidney and. In addition to flank or groin pain, referred pain may occur in other regions of the body, which can make diagnosis difficult. Cbc and chemistry panel buncreatinine urine dipstick, urinalysis and culture. Glomerular disease can result from many inherited or acquired disorders and can manifest in a variety of ways, ranging in severity from asymptomatic urinary abnormalities to acute kidney injury aki or endstage renal disease.
Hematuria haematuria is the presence of red blood cells in the urine. The spectrum of etiologies has a significant agedependence, whereby the workup of hematuria can differ between children, adults under the age of 35 years, and adults ages 35 years or older. Gross hematuria is defined as readily visible and microscopic hematuria as 5 rbchpf. Hematuria is classified as microscopic versus gross. Remember that hemolytic uremic syndrome is a common cause of acute kidney injury in pediatrics and typically does not involve red urine withwithout microscopic hematuria. Acute means the problem starts suddenly, worsens quickly, and lasts a short time. Hematuria may be grossly visible macroscopic hematuria or detectable only on urine examination called microscopic hematuria. Familial alports syndrome glomerulonephritis hematology hemoglobinopathy, coagulopathy infection viral, bacterial, fungal. We discuss the common causes of hematuria and how to evaluate it. Hematuria can be from prerenal causes when vascular damage occurs, such as trauma to the kidney, septicemia, and purpura hemorrhagica. In many such patients, particularly young adult patients, the hematuria is transient and of no consequence. For example, flank pain, nausea, and hematuria suggest a renal colic attack. Fabrication of nanopatterns on silicon surface by combining. You may be given contrast liquid to help your urinary tract show up better in the pictures.
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