Generally, hematuria is defined as the presence of 5 or more RBCs per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart.
may be gross/Macroscopic or Microscopic; may be symptomatic or asymptomatic, transient or persistent, may be painful or painless and either isolated or associated with proteinuria and other urinary abnormalities.
can be of glomerular or nonglomerular origin; nephrological/medical or urological or surgical:
- Thin basement membrane disease (benign familial hematuria)
- Alport syndrome
- IgA nephropathy (Berger’s dz)
- Hemolytic-uremic syndrome (HUS)
- Postinfectious glomerulonephritis
- Membranoproliferative glomerulonephritis
- Lupus nephritis
- Anaphylactoid purpura (Henoch-Schönlein purpura)
- Fibrinoid necrosis of the Glomeruli (as a result of malignant hypertension)
- Strenuous exercise – March hematuria
- Mechanical trauma (masturbation)
- Foreign bodies
- Urinary tract infection
- Sickle cell disease/trait
- Tumors (BPH, Ca Prostate, TCC)
- Drugs/toxins (NSAIDs, anticoagulants, captopril, cephalosporins, ciprofloxacin, furosemide, cyclophosphamide, ritonavir, indinavir)
- Anatomic abnormalities (hydronephrosis, polycystic kidney disease, vascular malformations)
1. Blood : CBC, BUN & Creatinine, Coagulation studies, Sickle, Ca++, PSA, serology
2. Urine : Urianalysis, microscopy (Dysmorphic RBC -> Glomerular), Culture & Sensitivity
3. Imaging: Ultrasound, X-ray, CT/ spiral CT, IVU, Voiding cystourethrogram (MCUG), radionucleotide studies
Relative indications for renal biopsy:
Abnormal renal function
Recurrent persistent hematuria.
Serologic abnormalities (abnormal complement, ANA, or dsDNA levels).
Recurrent gross hematuria.
A family history of end-stage renal disease
Other causes of Red Urine
Drugs : Hydroxocobalamin (for cyanide poisoning), warfarin, phenazopyridine, rifampin, ibuprofen, and deferoxamine
Foods : Carrots, Beets, blackberries
Factitious disorder/ Malingering
Contamination of menstrual blood