Hematuria - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2026-01-28T20:19:42Z

Differential Diagnosis

← Older revision		Revision as of 20:19, 28 January 2026
Line 34:		Line 34:
	==Differential Diagnosis==		==Differential Diagnosis==
	{{Hematuria DDX}}		{{Hematuria DDX}}
			{{Red urine DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Video */

2024-04-17T20:11:34Z

Video

← Older revision		Revision as of 20:11, 17 April 2024
Line 110:		Line 110:
	==References==		==References==
	<references/>		<references/>

	~~==Video==~~
	~~{{#widget:YouTube\|id=q4_O8kTArX4}}~~

	[[Category:Renal]]		[[Category:Renal]]
	[[Category:Urology]]		[[Category:Urology]]
	[[Category:Symptoms]]		[[Category:Symptoms]]

Patricklin at 03:09, 4 October 2023

2023-10-04T03:09:43Z

← Older revision		Revision as of 03:09, 4 October 2023
Line 1:		Line 1:
	''This page is for <u>adult</u> patients; for pediatric patients see [[hematuria (peds)]]''		''This page is for <u>adult</u> patients; for pediatric patients see [[hematuria (peds)]]''
	==Background==		==Background==
	*Make sure hematuria is not myoglobin or bleeding from non-urinary source		*Hematuria can be macroscopic/gross or microscopic
			**Microscopic hematuria generally defined as >3 RBCs per high-power field of an uncontaminated sample
			*Hematuria can also be divided into glomerular and nonglomerular causes
			*Make sure hematuria is not myoglobin (due to rhabdo), hemoglobinuria (due to hemolysis), or bleeding from non-urinary source (ex. menstruation)
	*Hematuria + pain suggests UTI or nephrolithiasis		*Hematuria + pain suggests UTI or nephrolithiasis
	*Hematuria + no pain suggests malignancy, hyperplasia, or vascular cause		*Hematuria + no pain suggests malignancy, hyperplasia, or vascular cause
Line 34:		Line 37:
	==Evaluation==		==Evaluation==
	[[File:Macroscopic hematuria.png\|thumb\|Macroscopic Hematuria algorithm]]		[[File:Macroscopic hematuria.png\|thumb\|Macroscopic Hematuria algorithm]]

	===Workup===		===Workup===
	*Labs:		====Labs====
	**[[Urinalysis]]		*[[Urinalysis]]
	***Microscopic hematuria associated with proteinuria suggests glomerular disease and requires further investigation (as an outpatient)		**Urine microscopy can show abnormal RBC morphologies suggesting glomerular source of hematuria
	**CBC - for anemia and thrombocytopenia		**Microscopic hematuria associated with proteinuria suggests glomerular disease and requires further investigation (as an outpatient)
	**BMP - for renal function		*Urine dipstick may be performed quickly in some centers but has high false-positive rate<ref>Saleem MO, Hamawy K. Hematuria. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534213/</ref>
	*~~Consider~~ CT ~~imaging~~ to assess for ~~renal tumors~~, stones, ~~or aneurysm~~		*CBC - for anemia and thrombocytopenia
			*BMP - for renal function
			*Coags


			====Imaging====
			*Utilize multiphasic CT urography ("hematuria protocol") to assess for pathology in the kidney and urinary collecting system<ref>Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. Am Fam Physician. 2013 Dec 1;88(11):747-54. PMID: 24364522.</ref>
			**A noncontrast phase is useful for visualizing stones or hydronephrosis
			**A nephrographic phase has contrast enhancing renal parenchyma, useful for pyelonephritis and renal tumors
			**A delayed excretory phase visualizes urothelial and bladder tumors
	*Ultrasound useful to assess for [[Renal ultrasound\|hydronephrosis]] or a [[Aortic ultrasound\|Abdominal Aortic Aneurysm]]		*Ultrasound useful to assess for [[Renal ultrasound\|hydronephrosis]] or a [[Aortic ultrasound\|Abdominal Aortic Aneurysm]]
			*Ultimately, cystoscopy and/or kidney biopsies may be necessary as follow-up procedures after the final disposition

	===Diagnosis===		===Diagnosis===
Line 60:		Line 74:
	**Hemodynamically stable without life-threatening cause of hematuria		**Hemodynamically stable without life-threatening cause of hematuria
	**Able to tolerate oral fluids, antibiotics, and analgesics as indicated		**Able to tolerate oral fluids, antibiotics, and analgesics as indicated
			**Able to void
	**No significant anemia or acute renal insufficiency		**No significant anemia or acute renal insufficiency

Line 79:		Line 94:
	***[[Proteinuria]]		***[[Proteinuria]]
	***Renal insufficiency		***Renal insufficiency
			*Consider nephrology referral for signs of glomerular hematuria such as concommittant AKI, proteinuria, dysmorphic RBCs, RBC casts

	===Admission===		===Admission===

Rossdonaldson1: /* Clinical Features */

2022-01-06T07:08:11Z

Clinical Features

← Older revision		Revision as of 07:08, 6 January 2022
Line 18:		Line 18:
	==Clinical Features==		==Clinical Features==
	[[File:HematuriaGross.jpg\|thumb\|Gross hematuria on urine sample.]]		[[File:HematuriaGross.jpg\|thumb\|Gross hematuria on urine sample.]]
			[[File:The presence of blood in urine bag.jpg\|thumb\|Hematuria in a foley bag.]]
	{{Types of hematuria}}		{{Types of hematuria}}

Rossdonaldson1: /* Clinical Features */

2022-01-06T07:06:20Z

Clinical Features

← Older revision		Revision as of 07:06, 6 January 2022
Line 17:		Line 17:

	==Clinical Features==		==Clinical Features==
			[[File:HematuriaGross.jpg\|thumb\|Gross hematuria on urine sample.]]
	{{Types of hematuria}}		{{Types of hematuria}}

Rossdonaldson1: /* Diagnosis */

2021-07-28T22:06:47Z

Diagnosis

← Older revision		Revision as of 22:06, 28 July 2021
Line 43:		Line 43:
	===Diagnosis===		===Diagnosis===
	*Based on [[UA]]		*Based on [[UA]]
	*Isolated hematuria with dysmorphic red cells or red cells with a decreased mean corpuscular volume (MCV), should prompt an evaluation for glomerulopathy (e.g., IgA nephropathy & Alport's syndrome)<ref>Ingelfinger, J. (2021). Hematuria in Adults. The New England Journal of Medicine, 385(2), 153–161. </ref>		**Isolated hematuria with dysmorphic red cells or red cells with a decreased mean corpuscular volume (MCV), should prompt an evaluation for glomerulopathy (e.g., IgA nephropathy & Alport's syndrome)<ref>Ingelfinger, J. (2021). Hematuria in Adults. The New England Journal of Medicine, 385(2), 153–161. </ref>
	*Isolated hematuria may be elusive. In some series, more than half of the patients have microhematuria with no definable cause.<ref>Ingelfinger, J. (2021). Hematuria in Adults. The New England Journal of Medicine, 385(2), 153–161</ref>		**Isolated hematuria may be elusive. In some series, more than half of the patients have microhematuria with no definable cause.<ref>Ingelfinger, J. (2021). Hematuria in Adults. The New England Journal of Medicine, 385(2), 153–161</ref>

	==Management==		==Management==

Rossdonaldson1: /* See Also */

2021-07-28T22:05:48Z

Rossdonaldson1: /* See Also */

2021-07-28T22:05:06Z

Jonrako: /* Diagnosis */

2021-07-11T15:35:24Z

Diagnosis

← Older revision		Revision as of 15:35, 11 July 2021
Line 44:		Line 44:
	*Based on [[UA]]		*Based on [[UA]]
	*Isolated hematuria with dysmorphic red cells or red cells with a decreased mean corpuscular volume (MCV), should prompt an evaluation for glomerulopathy (e.g., IgA nephropathy & Alport's syndrome)<ref>Ingelfinger, J. (2021). Hematuria in Adults. The New England Journal of Medicine, 385(2), 153–161. </ref>		*Isolated hematuria with dysmorphic red cells or red cells with a decreased mean corpuscular volume (MCV), should prompt an evaluation for glomerulopathy (e.g., IgA nephropathy & Alport's syndrome)<ref>Ingelfinger, J. (2021). Hematuria in Adults. The New England Journal of Medicine, 385(2), 153–161. </ref>
			*Isolated hematuria may be elusive. In some series, more than half of the patients have microhematuria with no definable cause.<ref>Ingelfinger, J. (2021). Hematuria in Adults. The New England Journal of Medicine, 385(2), 153–161</ref>

	==Management==		==Management==

Jonrako: /* Diagnosis */

2021-07-10T12:09:46Z

Diagnosis

← Older revision		Revision as of 12:09, 10 July 2021
Line 43:		Line 43:
	===Diagnosis===		===Diagnosis===
	*Based on [[UA]]		*Based on [[UA]]
			*Isolated hematuria with dysmorphic red cells or red cells with a decreased mean corpuscular volume (MCV), should prompt an evaluation for glomerulopathy (e.g., IgA nephropathy & Alport's syndrome)<ref>Ingelfinger, J. (2021). Hematuria in Adults. The New England Journal of Medicine, 385(2), 153–161. </ref>

	==Management==		==Management==

← Older revision		Revision as of 22:05, 28 July 2021
Line 88:		Line 88:

	==See Also==		==See Also==
	*[[Hematuria (~~Peds~~) ~~DDx~~]]		*[[Hematuria (peds)]]

	==References==		==References==

← Older revision		Revision as of 22:05, 28 July 2021
Line 88:		Line 88:

	==See Also==		==See Also==
	[[Hematuria (Peds) DDx]]		*[[Hematuria (Peds) DDx]]

	==References==		==References==