Hematuria

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:

  • Glomerular hematuria

    • 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)
    • PNH
    • Fibrinoid necrosis of the Glomeruli (as a result of malignant hypertension)
  • Nonglomerular hematuria

    • Fever
    • Strenuous exercise – March hematuria
    • Mechanical trauma (masturbation)
    • Menstruation
    • Foreign bodies
    • Urinary tract infection
    • Hypercalciuria/urolithiasis
    • Sickle cell disease/trait
    • Coagulopathy
    • Tumors (BPH, Ca Prostate, TCC)
    • Drugs/toxins (NSAIDs, anticoagulants, captopril, cephalosporins, ciprofloxacin, furosemide, cyclophosphamide, ritonavir, indinavir)
    • Anatomic abnormalities (hydronephrosis, polycystic kidney disease, vascular malformations)
    • Hyperuricosuria

Workup
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:

  • Significant proteinuria
  • 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

 

Ref: Medscape

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