Hematuria - Differential Diagnosis Framework Gross Hematuria: Red/Dark urine • 1ml blood/liter urine can induce color change • Gross hematuria + clots ➔ Lower Urinary tract source • Hematuria: 3 or more RBC/HPF spun urine sediment Microscopic Hematuria: • Detectable by examination of urine sediment by microscopy (Urinalysis or dipstick) Glomerular Hematuria: • Immune mediated injury • Noninflammatory glomerulopathies • Causes of Glomerular Bleeding - IgA nephropathy - Thin basement membrane disease - Alport syndrome - Mesangioproliferative GN without IgA deposits - Post-infectious GN - Loin pain hematuria syndrome: • Flank pain + gross or microscopic hematuria • Signs of glomerular hematuria: - RBC casts → Diagnostic of GN or vasculitis - Dysmorphic RBC - Brown urine - Proteinuria → Suggestive of glomerular disease Renal Causes of Hematuria: • Pyelonephritis • Hydronephrosis • Malignant HTN • Renal vein thrombosis • Renal artery embolism • AVM • Papillary necrosis (Sickle cell) • Renal Mass Ureteral Causes of Hematuria: • Stone • Stricture • Malignancy • Fistula • Post-procedural • Nutcracker syndrome: - Compression of left renal vein between aorta and SMA - Can cause microscopic and gross hematuria Bladder Causes of Hematuria: • Malignancy • Cystitis • Bladder stones/polyps • Radiation • Rapid decompression • Diverticulum Urethra/Prostate Causes of Hematuria: • Urethritis • Urethral diverticulum • Traumatic catheterization • BPH • Prostate cancer • TURP/Biopsy Renal/Ureter/Bladder (Upper and Lower urinary tract) Causes of Hematuria: • Infection (Viral/Bacterial) • TB • Schistosomiasis • Urolithiasis • Malignancy • Trauma • Intervention • Exercise induced bleeding • Anticoagulation Pseudohematuria: • GI bleed • Menstruation/Postpartum • Drugs: Pyridium, Phenytoin, Rifampin • Beets • Pigmenturia #Hematuria #Differential #Diagnosis #causes #urology #nephrology #renal #urine #blood
