Hematuria is termed microscopic when the urine is visually normal in color but is found to contain blood on chemical analysis or microscopic evaluation. An anatomical framework is helpful in developing a comprehensive differential diagnosis. Include the proportion of patients with hematuria who have diagnosis x, diagnosis y, negative evaluation, etc. 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. Signs and symptoms the first step in the evaluation of hematuria consists of a detailed and a thorough physical examination. Rifampicin, nitrofurantoin, sulfonamides, adriamycin. Differential diagnosis of hematuria microscopic hematuria in 5 patients. When hematuria is encountered, physicians sometimes fail to include vascular diseases in the differential diagnosis because of their rare association with hematuria. Hematuria is termed gross, or macroscopic, when there is sufficient blood present to color the urine red or brown. In rare cases, hematuria is caused by lifethreatening vascular diseases. It may present as urine that is red to brown, or as frank blood. Hematuria and proteinuria in children american academy. Glomeruli are the blood cleaning units of the kidneys and are believed to be the source of the bleeding in lphs.
A diagnosis of hematuria is confirmed by demonstration of red blood cells in the. Include for each of the most common diagnoses what historical elements, clinical signs, and medical testing makes this diagnosis very likely. Plan the appropriate initial evaluation for hematuria and proteinuria and interpret laboratory findings essential for diagnosis. Common urological causes of haematuria include urinary tract infection and ureteric and renal stones. Hematuria is an extremely common condition, and almost always requires a complete urologic evaluation. Microscopic hematuria is present when microscopic inspection of at least 2 properly collected urine specimens show 3 rbcs per highpowered field hpf. Hematuria is the presence of blood in a persons urine. Sickle cell trait and gross hematuria kidney international. We discuss the common causes of hematuria and how to evaluate it. Unexplained persistent gross hematuria in pregnancy. Hematuria free download as powerpoint presentation. Assessment of asymptomatic microscopic hematuria in adults. Gross hematuria is red or brown urine, sometimes with blood clots.
In addition, the evidence primarily is based on data from male patients. Differential diagnosis of red urine it does not always need to be blood o haematuria. Hematuria haematuria is the presence of red blood cells in the urine. A urine dipstick analysis is a highly sensitive measure for detection of blood, but it lacks specificity. The term chronic indigestion is probably not the best one, but the author has defined indigestion as a name signifying a certain group of abdominal symptoms and adds that unfortunately there is no constant relationship between these symptoms and their cause. It is often found incidentally as a result of routine examination in patients without urinary tract symptoms. An algorithm for the evaluation of essential hematuria.
In this chapter we provide an overview of hematuria and discuss important aspects of the history and physical examination. Hematuria defined as the presence of blood or red blood cells in the urine. Loin pain hematuria syndrome clinical kidney journal. Visible gross hematuria is urine that is visibly discolored by blood or blood clot. In many patients, particularly young adult patients, the hematuria is transient and of no consequence. Pdf unexplained persistent gross hematuria in pregnancy.
Evaluation of visible hematuria differential diagnosis. Hematuria has many causes, and a broad urological and nephrological differential diagnosis must be considered. Diagnosis and management of incidentally discovered microscopic hematuria figure 1. Trauma to the kidney can occur from a direct blow or deceleration. Although an uncommon occurrence in children, it is nevertheless a disturbing finding for both the affected child and hisher family. Quantitative assessment of proteinuria is useful for detection, differential diagnosis, prognosis, and. 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. A positive result for blood on a urine dipstick can also be due to bilirubinuria, hemoglobinuria, hematuria, or contamination of urine with oxidizing compounds disinfectants such as bleach or iodine. Rare causes of hematuria associated with various vascular. Symptom to diagnosis an evidence based guide 2nd edition. Conversely, 40% of patients with gross hematuria have no diagnosis made. The urinary tract is the bodys drainage system for removing wastes and extra fluid.
Evaluation and differential diagnosis of hematuria. Loin pain hematuria syndrome genetic and rare diseases. Proteinuria differential diagnosis of hematuria microscopic hematuria in 5 patients. Visible hematuria, even when transient or asymptomatic, may indicate a significan. Hematuria is caused by your kidneys allowing blood cells to leak into the urine. If the clinical evaluation and urinalysis suggest a glomerular nephrological cause of. The third edition is enhanced by the addition of five new chaptersbleeding disorders, dysuria, hematuria, hypotension, and sore throatas well as a greater emphasis on how to master the process of working from patient level data signs, symptoms, and. 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. The differential diagnosis of hematuria is often divided into microscopic hematuria or gross hematuria. Hematuria refers to the presence of blood in the urine, as defined as more than 5 to 10 red blood cells per highpower field rbchpf. 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.
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. The patient reported having had dark urine for at least 2 months, but after a recent 2h and 30min air travel, her urine became bright red and she began passing dark clots. A 35yearold africanamerican woman with sickle cell trait presented to our medical center with severe gross hematuria. The urologist must have a thorough knowledge of the urologic causes of hematuria as well as the nonurologic causes. 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 urine macroscopic or microscopic. In addition to ruling out other possible causes, the episodes loin pain and blood in the urine must persist or be. The exact definition of microscopic hematuria is debated, but is defined by one group as 3 red blood cellshigh power microscopic field. Likewise, radiologists often fail to do so because of the low frequency of occurrence of these diseases. It may be grossly visible macroscopic or detectable only on urine examination called microscopic. Understanding the differential diagnosis may divide the differential diagnosis into intrarenal and extrarenal causes. Microscopic hematuria is a frequent reason for referral to urology. Hematuria or blood in the urine indicates that bleeding is occurring somewhere in the urinary tract. Etiology and evaluation of hematuria in adults uptodate.
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. Macroscopic hematuria is red or brown urine, sometimes with blood clots. Algorithm for the diagnosis and management of incidentally discovered microscopic hematuria. It is characterized by steady or intermittent loss of small amounts of protein and blood in the urine. Differential diagnosis of hematuria abstract hematuria is the main symptom of many urological and nephrological diseases. Key points even if a dipstick test for hematuria is positive, a key. Recognize the criteria for diagnosis of proteinuria and hematuria. Haematuria differential diagnosis of red urine it does not always. This book is a practical outline of the common causes of chronic indigestion. Hematuria differential diagnosis usmle step 2 cs mnemonics. The differential diagnosis of spastic diplegia richard huntsman, edmond lemire, jonathon norton, anne dzus, patricia blakley and simona hasal arch dis child published online november 18, 2014. The causes of hematuria include urinary tract infection uti, bladder or kidney stones, kidney disease, use of certain medications, strenuous exercise, and trauma. Recognize serious causes of hematuria and proteinuria that warrant immediate referral. The differential diagnosis of hematuria is often divided into microscopic hematuria or macroscopic hematuria.
Pdf evaluation and management of hematuria researchgate. Asymptomatic proteinuria and hematuria syndrome kidney. While the causes of hematuria are extensive, the most common differential diagnosis for both microscopic and gross hematuria. In the absence of highquality scientific evidence, the recommendations of current guidelines for the diagnostic evaluation of hematuria are not uniform. Loin pain hematuria syndrome lphs was first described in 1967 by little et al. Diagnostic tests and algorithms used in the investigation of haematuria. As little as 1 ml of blood can impart color to 1 liter of urine. Canadian guidelines for the management of asymptomatic. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. A wide differential diagnosis must be considered if hematuria persists longer than 24 to 72 hours. In many such patients, particularly young adult patients, the hematuria is transient and of no consequence. 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. Pdf causes of hematuria can range from benign conditions such as urinary tract infection to serious.
This translates into a large number of false positives, in which case, the urine dipstick is positive, but microscopy reveals fewer than 5 to 10 rbchpf. 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. In addition, she started experiencing generalized fatigue, weakness, and mild dizziness. 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. Although there is generally no debate about the need to fully investigate patients with gross hematuria, there is often controversy regarding the approach to the. Hematuria that is not explained by an obvious underlying condition eg, cystitis, ureteral stone is fairly common. The leukocyte differential may show eosinophilia in parasitic or allergic conditions, or it may reveal lymphocytosis in childhood viral illnesses. On the other hand, there is an appreciable risk of malignancy in older patients eg, over age 35 years with hematuria, even if transient.