In this article, we provide an overview of the causes of hematuria and of. Pdf causes of hematuria can range from benign conditions such as urinary tract infection to serious conditions such as bladder cancer. 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. Differential diagnosis of hematuria microscopic hematuria in 5 patients. Key points even if a dipstick test for hematuria is positive, a key.
Diagnosis, evaluation and followup of asymptomatic microhematuria in adults. Haematuria differential diagnosis of red urine it does not always. 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. These include the urinary system, female reproductive system, and integumentary system. What is the differential diagnosis for a solid, enhancing renal mass. Common urological causes of haematuria include urinary tract. Medical history and urine analysis are cornerstones for planing rational further imaging and endoscopic diagnosis. The most important test in the evaluation of hematuria is a microscopic examination of the urine. Cbc and chemistry panel buncreatinine urine dipstick, urinalysis and culture. The differential diagnosis of hematuria is often divided into microscopic hematuria or gross hematuria. Macroscopic hematuria is red or brown urine, sometimes with blood clots. We discuss the common causes of hematuria and how to evaluate it.
The wide differential diagnosis would suggest a meticulous yet specific diagnostic workup depending on the individual clinical features and natural history. In many patients, particularly young adult patients, the hematuria is transient and of no. Normal values for albumin excretion and levels that define microalbuminuria have been discussed earlier. It may be due to injury to the kidneys, urinary tract, prostate, or genitals. Although the differential diagnosis for hematuria is extensive, most cases are isolated and benign. Gross hematuria gross hematuria is suspected because of the presence of red or brown urine. The algorithm for evaluating a child with microscopic hematuria is shown in figure 1.
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. People with drugrelated hematuria will improve if they stop taking the medication that caused the problem. Evaluation of visible hematuria differential diagnosis of. As we have seen, painless hematuria may be caused by numerous reasons so only the differential diagnosis is the best method to detect the underlying cause. An anatomical framework is helpful in developing a comprehensive differential diagnosis. The most common differential diagnoses for hematuria are uti, urolithiasis.
In addition to ruling out other possible causes, the episodes loin pain and blood in the urine must persist or be. This is often associated with fever and if the patient has had a recent infection like streptococcus. Glomeruli are the blood cleaning units of the kidneys and are believed to be the source of the bleeding in lphs. Differential diagnosis of hematuria anatomy renal cyst, avm, hydronephrosis boulders renal stone, hypercalciuria cancer wilms tumor, adenocarcinoma drugrelated cyclophosphamide exercise foreign body. Loin pain hematuria syndrome lphs is diagnosed when all other nonglomerular causes of the symptoms have been ruled out known as a diagnosis of exclusion. On the other hand, there is an appreciable risk of malignancy in older patients eg, over age 35 years with hematuria, even if transient. Urinary cytology, although controversial, often constitutes part of the initial work up for hematuria. Having blood in your urine doesnt always mean you have a medical problem. 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. What is initial or terminal hematuria and what diagnosis does that suggest. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. In this chapter we provide an overview of hematuria and discuss important aspects of the history and physical examination. Canadian guidelines for the management of asymptomatic.
The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. An algorithm for the evaluation of essential hematuria. This is a pdf file of an unedited manuscript that has been accepted for publication. 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. Red blood cells in the urine can come from the kidney where urine is made or anywhere in the u. This chapter does not discuss patients suspected of having a renal or ureteral calculus, who present with flank pain and hematuria. Hematuria defined as rbc 25 cells under hpf can be detected by dipstick false positive. Differential diagnosis of hematuria and microhematuria abnormal urine color. Sep 02, 2019 the treatment of hematuria depends on its cause. Positive urine dipstick when urine spun in centrifuge the entire fluid will. It may be grossly visible macroscopic or detectable only on urine examination called microscopic. However, fewer rbcs from just 1 specimen should not.
Full text full text is available as a scanned copy of the original print version. Get a printable copy pdf file of the complete article 509k, or click on a page image below to browse page by page. Hematuria at the start of urination suggests a problem in the urethra distal to the urogenital diaphragm, while hematuria throughout uri nation suggests upper urinary tract or upper bladder disease, and hematuria at the end of urination suggests a problem in the bladder neck or the prostatic urethra. It is interesting that the case report herein certainly cannot be. Positive urine dipstick when urine spun in centrifuge the entire fluid will remain red whereas whole red blood. This discussion includes both gross and microscopic hematuria. Hematuria is the medical term for red blood cells in the urine. In contrast, patients with glomerular disease excreted 40120 million rbcs.
Trauma to the kidney can occur from a direct blow or deceleration. Hematuria has many causes, and a broad urological and nephrological differential diagnosis must be considered. Red blood cells in urine macroscopic or microscopic. There are numerous causes of microhematuria, and the answer can often be found by considering the possible differential diagnoses. Recognize that hypercalciuria can be symptomatic even in the absence of a kidney stone. 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.
Hematuria haematuria is the presence of red blood cells in the urine. Evaluation of visible hematuria differential diagnosis of symptoms. Since the 2010 dutch guideline on hematuria was problembased, this served as an illustration for such an approach conclusion. Initial exclusion of other differential diagnosis based on the absence of certain clinical symptoms and signs is reasonable. Rapid and accurate evaluation and diagnosis may prevent serious complications. Urinary tract infection dysuria, polyuria, hematuria, can progress to pyelonephritis primary dysmenorrhea history of menstrual periods and regularity, consider sexual. However, presenting at 2018 avma convention in denver, colorado, dr. In general, people with exerciserelated hematuria do not need any treatment other than to modify their exercise programs.
In 1998, the canadian urological association published patient guidelines for asymptomatic hematuria. Microscopic hematuria is present when microscopic inspection of at least 2 properly collected urine specimens show 3 rbcs per highpowered field hpf. The presentation in bladder cancer may resemble urinary tract infection uti, or the 2 conditions may coexist. Diagnosis and management of hematuria surgical clinics. Utis are usually associated with irritative voiding symptoms eg, dysuria, frequency, urgency. If timed urine collection is used, the results are expressed as milligrams of albumin24 hours or micrograms of albumin min. A diagnosis of hematuria is confirmed by demonstration of red blood. Common differential diagnoses and potential complications 4.
Learning objectives by participating in this educational program, health care providers can expect to. 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. Proteinuria differential diagnosis of nonglomerular hematuria approach to patients with asymptomatic. In many patients, particularly young adult patients, the hematuria. Asymptomatic microscopic hematuria in adults canadian guidelines for the management of asymptomatic microscopic hematuria in adults tim wollin, md. Hematuria may be an indication of a serious blood clotting or platelet disorder. The causes of hematuria include urinary tract infection uti, bladder or kidney stones, kidney disease, use of certain medications, strenuous exercise, and trauma. Approach to hematuria identify origin of the blood glomerular hematuria nonglomerular hematuria. Haematuria is most accurately defined as the presence of three or more red blood cells per highpowered field in two of three properly collected urinalysis specimens 1, 2. Christopher cheung approach to pediatric abdominal.
Hematuria is the condition of having blood in the urine. Hematuria may be grossly visible macroscopic hematuria or detectable only on urine examination called microscopic hematuria. Hematuria defined as the presence of blood or red blood cells in the urine. Evaluation of nonvisible hematuria differential diagnosis. Differential diagnosis of loin pain hematuria syndrome. Macroscopic haematuria a urological approach racgp. The differential diagnosis includes renal, ureteral, bladder, and urethral injury. Jul 17, 2014 complete urological evaluation for haematuria includes a full history and physical examination, laboratory analysis, and radiological imaging of the upper urinary tract followed by cystoscopic examination of the urinary bladder. Assessment of asymptomatic microscopic hematuria in adults.
In the absence of highquality scientific evidence, the recommendations of current guidelines for the diagnostic evaluation of hematuria are not uniform. Approximately 30% of children with isolated hematuria may have elevated urinary calcium levels. Differential diagnosis the differential diagnosis for chronic phase cml. We then discuss the evaluation and differential diagnosis of hematuria, including unusual urologic causes and the more common nonurologic causes of hematuria.
Elsheikh, md cleveland clinic introduction majority of ut malignancies are urothelial ca the main function of urine cytology is dx of uc focus on a practical approach to dx of uc low grade urothelial neoplasms high grade urothelial ca. Evaluation and differential diagnosis of hematuria springerlink. Hematuria is a complex condition with a multitude of causes and treatments. Urine sediment after centrifuge normally contains 2 to 3 rbcs per high power field rbchpf on microscopic exam. It can be caused by a bleeding disorder or certain medications, or by stones, infection, or tumor. Just because you see blood in the urine, it doesnt mean its from the urinary tract, he emphasized. Gross hematuria is red or brown urine, sometimes with blood clots. Etiology and evaluation of hematuria in adults uptodate. Evaluation of asymptomatic microscopic hematuria in adults. Redcellvolume distribution curves in diagnosis of glomerular and. Because results of repeat urinalysis after 48 to 72 hours should be negative in patients with this. A traditional approach to quantifying hematuria is by counting the total number of rbcs in a timed 12 hour urine sample.
Differential diagnosis of hematuria r2 vs 20200109. Most patients present with both manifestations, but some present with loin pain or hematuria alone. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. Loin pain hematuria syndrome genetic and rare diseases. The patient was otherwise healthy, had no complaints, no significant pmh and physical exam was unremarkable including a normal blood pressure on no medications. Gross hematuria is defined as readily visible and microscopic hematuria as 5 rbchpf. Loin pain hematuria syndrome lphs is a poorly defined disorder characterized by recurrent or persistent loin flank pain and hematuria that appears to represent glomerular bleeding. Exerciseinduced hematuria is a relatively common, selflimited, and benign condition. Christopher cheung approach to pediatric abdominal pain. This article will discuss the differential diagnosis of haematuria from a urological perspective. In many patients, particularly young adult patients, the hematuria is transient and of no consequence. The differential diagnosis includes various techniques, such as dipstick test, imaging test, urinalysis, blood test and cystoscopy. Hematuria that is not explained by an obvious underlying condition eg. The differential diagnosis of dysuria is summarized in.
Common urological causes of haematuria include urinary tract infection and ureteric and renal. Review the presentation and differential diagnosis of glomerular hematuria. They may also experience nausea, vomiting, edema, sore throat, rash, arthralgia, dark urine. Familial alports syndrome glomerulonephritis hematology hemoglobinopathy, coagulopathy infection viral, bacterial, fungal. Antibiotics typically will cure infectionrelated hematuria. Both utis and bladder cancer cause hematuria, and bacteriuria occurs in about 50% of patients with squamous cell carcinoma scc. Hematuria is caused by your kidneys allowing blood cells to leak into the urine. Diagnosis and treatment of chronic myeloid leukemia cml in 2015.
A wide differential diagnosis must be considered if hematuria persists longer than 24 to 72 hours. Lulich stressed the benefit of taking an organized approach to finding the cause of hematuria in small animals. Visible hematuria, even when transient or asymptomatic, may indicate a significant disease process and always requires further investigation. Bladder cancer differential diagnoses medscape reference. Differential diagnosis of red urine it does not always need to be blood o haematuria. Haematuria can be microscopic or macroscopic visible to the naked eye in nature, but both forms may be the sole manifestation of underlying serious pathology. Hematuria differential diagnosis usmle step 2 cs mnemonics. 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.
Postinfectious glomerulonephritis underlying etiology in 10% of pediatric cases 4, nephrotic syndrome, henoch schonlein purpura, iga nephropathy, systemic lupus erythematosus, wilms tumor, differential diagnoses to be considered in patients of all ages. Evaluation of visible hematuria differential diagnosis. However, even among older patients, a urologic cause for the hematuria can often not be identified 61 percent in a series of 1930 patients referred to a hematuria clinic. The main issues disputed are related to the detection and definition of significant microscopic hematuria, which patients should be investigated, and how should they be evaluated. 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. Abnormal urine color can simulate hematuria, microscopic examination of the urine shows no blood cells.
Hematuria or blood in urine hematuria is blood in the urine. The differential diagnosis of hematuria is often divided into microscopic hematuria or macroscopic hematuria. Given the a priori low likelihood of cancer in hematuria, risk categories should be established. Many diseases can present with hematuria and loin pain, most notably cancers, including metastatic choriocarcinoma of the kidney, an occult rectal adenocarcinoma causing a urinoma by obstructing ureteral outflow, renal angiomyolipoma, 47 cases of kidney cancer, ovarian cancer, and anaplastic tcell lymphoma with unilateral upper. Differential diagnosis for microscopic hematuria using isabel. Normals excreted a mean of 66,000 rbcs with a range of 0425,000.
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