Causes of Hematuria - Differential Diagnosis Algorithm
Red blood cells on urine microscopy. Must exclude false positives from myoglobinuria, beet, drugs (pyridium, phenytoin, rifampin, nitrofurantoin), or menstruation
Extraglomerular - Upper Tract (above bladder)
• Vascular
• Tubulolnterstitial
• Calculi
• Neoplasm/Cyst
Extraglomerular - Lower Tract (bladder & below)
• Trauma
• Neoplasm
• BPH
• Calculi
Glomerular (Dysmorphic RBCs and/or RBC casts)
- Isolated Hematuria with benign sediment (injury to epithelial side of glomerular capillary wall)
• IgA nephropathy
• Thin GBM disease
• Hereditary nephritis (Alport's)
- Isolated Hematuria with active sediment (injury to the endothelial side of glomerular capillary wall)
• Anti-GBM antibodies
• Immune-complex deposition (IgA, post-strep, lupus)
• Pauci-immune disease (Granulomatosis with polyangiitis/microscopic polyangiitis)
- Hematuria with active sediment and >3.5g/day (nephrotic range) proteinuria (injury to both endothelial and epithelial capillary wall)
• Membranoproliferative glomerulonephritis
• Lupus glomerulonephritis
• Post-Infectious glomerulonephritis
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