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. Gross hematuria gh or microscopic hematuria mh may be a clue to serious urologic disease, including malignancy. Evaluation and differential diagnosis of hematuria springerlink. Hematuria is a common issue faced by primary physicians who care for children. Hematuria and proteinuria are common findings in primary care practice.
Assessment of asymptomatic microscopic hematuria in adults aafp. Gross hematuria is red or brown urine, sometimes with blood clots. The presence of red cell casts and preponderance of dysmorphic cells on phase contrast microscopy are consistent with glomerular bleeding. Etiology and evaluation of hematuria in adults uptodate. 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. It may be due to injury to the kidneys, urinary tract, prostate, or genitals. Hematuria may be grossly visible macroscopic hematuria or detectable only on urine examination called microscopic hematuria. 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. The most important test in the evaluation of hematuria is a microscopic examination of the urine. Having blood in your urine doesnt always mean you have a medical problem. It should be part of the differential diagnosis for any normocytic or. Microscopic hematuria in the setting of urinary tract infection should resolve after. Pdf evaluation and management of hematuria researchgate.
Microscopic hematuria refers to the detection of blood on urinalysis or urine microscopy. Asymptomatic proteinuria and hematuria syndrome kidney. Microscopic hematuria is present when microscopic inspection of at least 2 properly collected urine specimens show 3 rbcs per highpowered field hpf. Haematuria can be a symptom of acute kidney injury or chronic kidney. The differential diagnosis includes immunoglobulin a nephropathy, membranoproliferative glomerulonephritis, and hereditary nephritis, although the latter. 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. Get the facts about hematuria urology care foundation. An algorithm for the evaluation of essential hematuria. However, there is no consensus concerning either the level of mh to evaluate or the extent of the evaluation. A wide differential diagnosis must be considered if hematuria persists longer than 24 to 72 hours. Followup testing if no underlying cause for hematuria is found during the initial evaluation, followup urine testing and blood pressure monitoring may be recommended every three to six months. In addition to detecting heme in intact red blood cells rbcs, urine dipsticks detect free hemoglobin and myoglobin, hence leading to. This refers to when your doctor considers possible conditions that could be causing your symptoms.
What is initial or terminal hematuria and what diagnosis does that suggest. 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 laboratory tests. Hematuria that is not explained by an obvious underlying condition eg. Trauma to the kidney can occur from a direct blow or deceleration. A complete physical examination can contribute to making a valid differential diagnosis. In many such patients, particularly young adult patients, the hematuria is transient and of no consequence 1. In many patients, particularly young adult patients, the hematuria is transient and of no. Macroscopic hematuria is red or brown urine, sometimes with blood clots. Bladder cancer overview types, pathophysiology, diagnosis, treatment. It is characterized by steady or intermittent loss of.
We evaluated the renal recipients who developed hematuria treated with a defined. Hematuria has many causes, and a broad urological and nephrological differential diagnosis must be considered. While it can cause great anxiety in the patient and family when it presents as gross hematuria, rarely does hematuria alone herald a serious illness during childhood. Pain, mass, and hematuria use to be considered the classic triad for the suspicion of renal cell cancer. 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. We discuss the common causes of hematuria and how to evaluate it. Differential diagnosis of hematuria abstract hematuria is the main symptom of many urological and nephrological diseases. Visible hematuria, even when transient or asymptomatic, may indicate a significant disease process and always requires further investigation. The differential diagnosis of hematuria is often divided into microscopic hematuria or macroscopic hematuria. Nov 29, 2017 blood in dog urine hematuria what it means and what you should do. It can be caused by a bleeding disorder or certain medications, or by stones, infection, or tumor. 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.
On the other hand, there is an appreciable risk of malignancy in older patients eg, over age 35 years with. Learning objectives by participating in this educational program, health care providers can expect to. Evaluation of visible hematuria differential diagnosis of symptoms. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. Hematuria and proteinuria in children american academy.
It may be grossly visible macroscopic or detectable only on urine examination called microscopic. Hematuria differential diagnoses medscape reference. Key points even if a dipstick test for hematuria is positive, a key question is whether this truly represents blood in the urine vs free myoglobin or hemoglobin. The purpose of this guideline is to provide a clinical framework for the diagnosis, evaluation, and followup of asymptomatic microhematuria amh. Then try this hematuria mnemonic for usmle step 2 cs. Painless hematuria without proteinuria should prompt a search for coagulation disorders, structural abnormalities, and cancer. An anatomical framework is helpful in developing a comprehensive differential diagnosis. I liked the differential diagnosis was bulleted and linked to. The etiology of hematuria and proteinuria includes a long. The identification of hematuria or proteinuria in an otherwise healthy child can cause anxiety to both the family and the pediatrician. In the absence of highquality scientific evidence, the recommendations of current guidelines for the diagnostic evaluation of hematuria are not uniform. Urinalysis usually reveals microscopic hematuria and sometimes proteinuria. Pdf causes of hematuria can range from benign conditions such as urinary. The underlying cause of the condition therefore needs to be investigated and diagnosed so that.
In this chapter we provide an overview of hematuria and discuss important aspects of the history and physical examination. This chapter does not discuss patients suspected of having a renal or ureteral calculus, who present with flank pain and hematuria. Although the prevalence of serious disease eg, malignancy is higher in patients with gross hematuria, microscopic hematuria may also indicate significant genitourinary pathology. This is especially true if you are at increased risk for bladder cancer. The blood may be visible, so that the urine appears reddish or darker than normal.
Hematuria differential diagnosis free medical content. Assessment of asymptomatic microscopic hematuria in adults. Diagnosis, evaluation and followup of asymptomatic microhematuria amh in. 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 by the presence of an increased number of red blood cells rbcs in the urine that is visible to the naked eye.
A number of factors can increase your risk of bladder cancer, including. 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. However there is an appreciable risk of malignancy in patients over age 35 years with hematuria, even if transient. Polypoid cystitis is an uncommon disease in dogs characterized by proliferation of the bladder mucosa, which can cause thickening of the bladder wall, papillarylike projections from the mucosal surface, and polyps that extend into the bladder lumen. Positive urine dipstick when urine spun in centrifuge the entire fluid will remain red whereas whole red blood. Imaging studies and cystoscopy usually are necessary for diagnosis after an inconclusive initial evaluation, especially.
However, today most cancers are found serendipitously at the time of an abdominal ultrasound. Hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or lifethreatening. The differential diagnosis of hematuria is often divided into microscopic hematuria or gross hematuria. Microscopic hematuria is a frequently encountered clinical problem in kidney graft recipients. I found the introduction focused and thought it gave a good overview of the page.
Transient unexplained hematuria urinary tract infection urethritis benign prostatic hyperplasia stones urinary calculi menstruation. In many patients, particularly young adult patients, the hematuria is transient and of no consequence. There are numerous causes of microhematuria, and the answer can often be found by considering the possible differential diagnoses. Abdominal pain, joint pain, and swelling are often present. Hematuria or blood in the urine indicates that bleeding is occurring somewhere in the urinary tract. Sep 02, 2019 hematuria an easy to understand guide covering causes, diagnosis, symptoms, treatment and prevention plus additional in depth medical information. Diagnosis, evaluation, and followup of asymptomatic. Cbc and chemistry panel buncreatinine urine dipstick, urinalysis and culture. Having trouble remembering all the important questions to ask during your patient encounter. Hematuria evaluation guidelines issued by acp clinical. For example, flank pain, nausea, and hematuria suggest a renal colic attack. The patient was otherwise healthy, had no complaints, no significant pmh and physical exam was unremarkable including a normal blood pressure on no medications. Other urine characteristics that help in distinguishing between glomerular and nonglomerular hematuria are discussed above. The wide differential diagnosis would suggest a meticulous yet specific diagnostic workup depending on the individual clinical features and natural history.
We then discuss the evaluation and differential diagnosis of hematuria, including unusual urologic causes and the more common nonurologic causes of hematuria. Evaluation of visible hematuria differential diagnosis of. Transient causes of microscopic hematuria include urinary tract infections utis which sometimes also cause macroscopic hematuria and strenuous exercise. Differential diagnosis is difficult but imperative for patient with chronic relapsing hematuria and graft survival.
Differential diagnosis for gross hematuria using isabel. By applying this process, you will be able to recognize specific diseases and prescribe the most effective therapy each chapter addresses one common complaint and begins with a case and guidance on how to organize. Hematuria differential diagnosis medical institution free. Haematuria can be a symptom of acute kidney injury or chronic ki dney. Medical history and urine analysis are cornerstones for planing rational further imaging and endoscopic diagnosis. This discussion includes both gross and microscopic hematuria. Symptom to diagnosis teaches you an evidencebased, stepbystep process for evaluating, diagnosing, and treating patients based on their clinical complaints. Urinalysis reveals red blood cell casts and mild proteinuria. The combination of hematuria plus proteinuria suggests glomerular disease. Hematuria defined as the presence of blood or red blood cells in the urine. Many conditions can cause hematuria, but the differential diagnosis can be simplified with a systematic approach.
Evaluation of hematuria in adults jama jama network. The next step in the differential diagnosis is localization of the bleeding. The image of visible hematuria is relevant and the anatomical image is also helpful to the reader. In the differential diagnostics a distinction is made between painful and pain free and between macrohematuria which is visible to the naked eye and microhematuria which is not visible. Transient unexplained hematuria urinary tract infection urethritis benign prostatic. Abnormal urine color can simulate hematuria, microscopic examination of the urine shows no blood cells. It does not in any way pretend to be an exhaustive survey of the various etiological explanations of the multitudinous gastrointestinal pathological conditions, nor does it attempt to detail the various unusual intraabdominal conditions which may also cause indigestion. You may have heard the term differential diagnosis thrown around by your doctor or others. Hematuria or blood in urine hematuria is blood in the urine.
Pan, in nelson pediatric symptombased diagnosis, 2018. Occurs with recurrent macroscopic hematuria associated with upper respiratory tract infection. A 2017 american college of obstetricians and gynecologists committee opinion on asymptomatic microscopic hematuria in women concluded that the patients sex should influence the differential diagnosis as asymptomatic microscopic hematuria in women is less likely to be associated with urinary tract malignancy than in men. 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. Differential diagnosis of hematuria and microhematuria abnormal urine color. Pdf causes of hematuria can range from benign conditions such as urinary tract infection to serious conditions such as bladder cancer. Evaluation of visible hematuria differential diagnosis. Although an uncommon occurrence in children, it is nevertheless a disturbing finding for both the affected child and hisher family. A 22 year old asian male was found to have hematuria during a routine school evaluation. The american college of physicians acp has published new guidelines for the clinical evaluation of patients with hematuria, as reported in the annals of internal medicine matthew nielsen, md. Proteinuria hematuria history of kidney disease hypertension fever, exertion. Older patients with painless gross hematuria should be considered at high risk for malignancy and urine cytology should be performed. Hematuria that is not explained by an obvious underlying condition eg, cystitis, ureteral stone is fairly common. Hematuria adult urologic conditions and treatments.
A 56yearold male, with a previous medical history of smoking 30 pack years and chronic obstructive pulmonary disease budesonide, presents to the emergency department for three days of painless hematuria. Symptom to diagnosis 2nd edition pdf free medical books. What is significant hematuria for the primary care physician. 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. Although the american academy of pediatrics eliminated routine urine screening from its preventive care guidelines a decade ago, many pediatricians continue to use screening urinalysis ua as part of their health supervision visits. A diagnosis of hematuria is confirmed by demonstration of red blood. If the clinical evaluation and urinalysis suggest a glomerular. Gross hematuria gross hematuria is suspected because of the presence of red or brown urine.
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