Hematuria

From IDWiki

Background

  • Microscopic hematuria: the presence of blood on urinalysis
  • Macroscopic or gross hematuria: the presence of visible blood in the urine

Etiologies

Differential Diagnosis

Macroscopic Hematuria

Investigations

  • Confirm hematuria
  • Consider nephrolithiasis based on clinical exam with or without imaging
    • Treat if identified
  • Consider urinary tract infection, based on clinical exam and urinalysis
    • Treat if identified, and repeat urinalysis following resolution of infection to assess for persistent hematuria
  • Assess for glomerular bleeding with urinary and serum albumin, serum creatinine, urine microscopy for dysmorphic RBCs, RBC casts, or WBC casts, and assess for hypertension or edema
    • Refer to Nephrology if present
  • Assess risk of structural cause, including age >35 years, smoking, prior macroscopic hematuria, exposure to benzenes or aromatic amines, heavy NSAID use, prior urologic disorder, lower urinary tract symptoms, recurrent UTIs, prior pelvic irradiation, prior alkylating agents such as cyclophosphamide, or prior aristolochic acid
    • CT abdomen/pelvis for urography (if not pregnant)
    • Urology to see for cystoscopy
  • Otherwise, consider ultrasound of kidney and bladders +/- cystoscopy