Hematuria, either gross or microscopic, in any patient warrants laboratory investigation. But also a rational and systematic approach to the problem of evaluating and treating. As part of diagnosis all patients should undergo a formal cystoscopy. This disorder follows a mild and nonprogressive course.
Differential diagnosis causes of urinary frequency, from the online textbook of urology by d. Kidney involvement as a presenting feature is rare and typically is asymptomatic. Nearly all forms of acute glomerulonephritis have a tendency to progress to chronic glomerulonephritis. The underlying cause of the condition therefore needs to be investigated and diagnosed so that. Certain strategies work better for different symptoms. Differential diagnosis explained, plus examples healthline. Not all are life threatening, and some are more serious than others. Proteinuria diagnosis of hematuria microscopic hematuria in 165 patients with no other renal or systemic findings. Common and important causes of painless hematuria for doctors and medical students this page is currently being written and will be available soon.
Hematuria is the condition of having blood in the urine. When you seek attention for a medical concern, your doctor uses the diagnostic process to determine the condition that may be. Extensive ddx o bladderkidneyprostate cancer o bph o nephrolithiasis o endometriosis o intrinsic glomerular disease o polycystic kidney disease. Hematuria is defined as the presence of blood or red blood cells in the urine. The incidence of microscopic hematuria in schoolchildren was estimated at 0. Urine sediment after centrifuge normally contains 2 to 3 rbcs per high power field rbchpf on microscopic exam. Article in german horstmann m1, franiel t, grimm mo. 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. The code is not valid for the year 2020 for the submission of hipaacovered transactions. Doctors usually recommend that people with asymptomatic proteinuria and hematuria have a physical examination and undergo urine testing once or twice a year. Therefore, radiologists should be familiar with the various imaging findings caused by vascular disease in. In many patients, particularly young adult patients, the hematuria is transient and of no consequence. Feb 24, 2020 nearly all forms of acute glomerulonephritis have a tendency to progress to chronic glomerulonephritis. In a study aimed at identifying clinical factors associated with delayed.
Hematuria is defined as the abnormal presence of red blood cells rbcs in the urine and is commonly divided into gross and microscopic hematuria. Transient unexplained hematuria urinary tract infection urethritis. However, fewer rbcs from just 1 specimen should not. Thin basement membrane disease tends to cause red blood cells in the urine, but causes excretion of smaller amounts of protein than iga nephropathy or hereditary nephritis and may not cause excretion of red blood cell casts. Evaluation of asymptomatic microscopic hematuria in adults. Asymptomatic proteinuria and hematuria syndrome kidney and. Evaluation of nonvisible hematuria differential diagnosis. Apr 24, 2019 the term hematuria refers to presence of blood in the urine.
Hematuria is termed gross, or macroscopic, when there is sufficient blood present to color the urine red or brown. However, a kidney biopsy is rarely done because the likelihood of finding a treatable disease is very low. In many such patients, particularly young adult patients, the hematuria is transient and of no consequence 1. These symptoms include pain on urination dysuria, feeling of incomplete voiding, cloudy urine, uncomfortable lower abdomen and frequent urination. We discuss the common causes of hematuria and how to evaluate it. Key points even if a dipstick test for hematuria is positive, a key. Asymptomatic proteinuria and hematuria syndrome kidney. Before making a diagnosis and starting therapy, however, other, nonprostatic sources of hematuria must be ruled out. Trauma, bleeding dyscrasias, polycystic kidney disease, renal arteriovenous malformation, renal vein thrombosis, nephrolithiasis, pyelonephritis, vasculitis, radiation or chemotherapy associated cystitis, schistosomiasis, and tuberculosis. Strategies for generating differential diagnoses a number of different strategies can be used to generate a differential diagnosis. Differential diagnosis of hematuria microscopic hematuria in 5 patients. Hematuria can be either gross ie, overtly bloody, smoky, or teacolored urine or microscopic. Hematuria haematuria is the presence of red blood cells in the urine.
Hematuria and decreased kidney function as initial signs. The term hematuria refers to presence of blood in the urine. This is a corrected version of the article that appeared in print. Rare causes of hematuria associated with various vascular. Get a printable copy pdf file of the complete article 466k, or click on a page image below to browse page by page. August 31, 2015 kirsten graff, md, pgy2 case 6 year old previously healthy girl presents with 1 week of dark urine parents first noticed dark urine on 7415 note that it starts out light, but darkens throughout the day, and is bright red toward the end of the day no dysuria, urgency, or increased frequency. Visible hematuria, even when transient or asymptomatic, may indicate a significan. Jan 03, 2019 generally, 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. Thirtyfive patients with gross hematuria were admitted to childrens memorial hospital from 1950 to 1967. The diagnosis can usually be made with a kidney biopsy.
An anatomical framework is helpful in developing a comprehensive differential diagnosis. Because urological cancer is more common in males, those men over 50 who present with hematuria should have a complete and thorough evaluation of the urinary. Generally, 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. In patients with acute lymphoblastic leukemia all, the most prevalent childhood cancer, 1 kidneyrelated complications may be discovered after the initial diagnosis is made or arise as a result of treatment. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. On the other hand, there is an appreciable risk of malignancy in older patients eg, over age 35 years with hematuria, even if transient. Hematuria is caused by your kidneys allowing blood cells to leak into the urine.
Guidelines for diagnosis of asymptomatic microhematuria. Malaria must be distinguished from other febrile illnesses to avoid mistreatment. Transient unexplained hematuria urinary tract infection urethritis benign prostatic hyperplasia stones urinary calculi menstruation contaminated urine exercise trauma atrophic vaginitis bladder cancer. In many such patients, particularly young adult patients, the hematuria is transient and of no consequence. Positive urine dipstick when urine spun in centrifuge the entire fluid will remain red whereas whole red blood.
At those times adding a different strategy often reveals more conditions. Differential diagnosis of diseases diseases of swine wiley. It may be gross visible to the naked eye or microscopic. Cbc and chemistry panel buncreatinine urine dipstick, urinalysis and culture. Hpi multiple uas positive for blood within 6 weeks uas also. Generally, hematuria is defined as the presence of 5 or more rbcs per highpower field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. It may present as urine that is red to brown, or as frank blood. Differential diagnoses to be considered in patients of all ages. Each of the other four subjects were diagnosed with speech andor language disorders without the presence of developmental apraxia of speech.
Hematuria may be an indication of a serious blood clotting or platelet disorder. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons. Hematuria is one of the most common urinary findings that result in children presenting to pediatric nephrologists. Frequently you start with inquiring about things that might give you hematuria of a nonspecific nature, such as fever, abdominal pain, dysuria. Evaluation of visible hematuria differential diagnosis. Frequency may be accompanied by a sensation of an urgent need to void urinary urgency. The chapter provides a general list of possible causes of rectal prolapses including a brief explanation. An algorithm for the evaluation of essential hematuria. Visible gross hematuria is urine that is visibly discolored by blood or blood clot. Among the causes of hematuria, vascular disease is extremely rare.
Microscopic hematuria in two or more urine samples is found in 1% to 2% of children 6 to 15. Recognition and differential diagnosis of psychosis in. These include the urinary system, female reproductive system, and integumentary system. 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. Urinary frequency is distinguished from polyuria, which is urine output of 3 lday. Incidental findings most patients, it will resolve risk factor for evaluating microscopic hematuria smoking history, palpable mass, trauma, family history, occupation dyes, age 40 years old, radiation pelvic. Definition o benign, selflimiting hematuria occurring after strenuous exercise o loss of intact rbcs into urine o 2 rbcs per hpf 1 2.
Hematuria and decreased kidney function as initial signs of. Hematuria is termed microscopic when the urine is visually normal in color but is found to contain blood on chemical analysis or microscopic evaluation. Differential dx strategies university of massachusetts. Peripheral neuropathy a 128hz tuning fork should be used to test the vibratory sensations in extremities. Bloody urine may be caused by abnormalities in the urinary tract or by disease processes elsewhere in the body that can affect the urinary tract.
Conversely, 40% of patients with gross hematuria have no diagnosis made. Medical history and urine analysis are cornerstones for planing rational further imaging and endoscopic diagnosis. Apr 24, 2019 hematuria or blood in the urine indicates that bleeding is occurring somewhere in the urinary tract. Diagnosis and management of hematuria researchgate. Urinary frequency merck manuals professional edition. Familial alports syndrome glomerulonephritis hematology hemoglobinopathy, coagulopathy infection viral, bacterial, fungal. Differential diagnosis of hematuria and microhematuria abnormal urine color.
Hemorrhagic cystitis or haemorrhagic cystitis is an inflammation of the bladder defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage. Differential diagnosis of hematuria anatomy renal cyst, avm, hydronephrosis boulders renal stone, hypercalciuria cancer wilms tumor, adenocarcinoma drugrelated cyclophosphamide exercise foreign body. Differential diagnosis george washington university. Assessment of asymptomatic microscopic hematuria in adults. The underlying cause of the condition therefore needs to. This page will be removed from your favorites links. As little as 1 ml of blood can impart color to 1 liter of urine. The direction and magnitude of this evaluation is dependent to a large extent on the age and sex of the patient and the presence or absence of a urinary tract infection. 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. It may be grossly visible macroscopic or detectable only on urine examination called microscopic. General info o may be gross or microscopic hematuria o resolves after period of rest typically within 2448 hrs2 o influenced by exercise intensity and duration3. The condition is characterized by irreversible and progressive glomerular and tubulointerstitial fibrosis, ultimately leading to a reduction in the glomerular filtration rate gfr and retention of uremic toxins. Diagnosis, evaluation and followup of asymptomatic microhematuria amh in adults.
After generating a differential, you may decide that you would like to expand upon it. R31 is a header nonspecific and nonbillable code code, consider using a code with a higher level of specificity for a diagnosis of hematuria. Important aspects of differential diagnosis psychiatric and psychotherapeutic perspective. Mar 10, 2016 conversely, 40% of patients with gross hematuria have no diagnosis made. Key ddx o myoglobinuria caused by rhabdomyolysis o march hemoglobinuria o uti 2. Causes and differential diagnosis hematuria may result from a great variety of causes. The differential diagnosis of the atypical infiltrate included b or tcell lymphoblastic leukemialymphoma, burkitt lymphoma, diffuse large bcell lymphoma, and myeloid sarcomachloroma. Patients with asymptomatic microhematuria should undergo assessments including a careful history, laboratory examination, and physical examination to rule out benign causes of asymptomatic microhematuria, including infection, menstruation, vigorous exercise, medical. Evaluation of visible hematuria differential diagnosis of. Visible hematuria, even when transient or asymptomatic, may indicate a significant disease process and always requires further investigation. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. Hematuria or blood in the urine indicates that bleeding is occurring somewhere in the urinary tract. Gross hematuria in the first month of life is a rare occurrence. Hematuria that is not explained by an obvious underlying condition eg, cystitis, ureteral stone is fairly common.
People may be frightened by finding blood in their urine but this is rarely a symptom of any life threatening condition. Diagnosis of asymptomatic microhematuria is not based on dipstick results. For the same reason, radiologists seldom include vascular diseases in the differential diagnosis, even though angiography or interventional techniques are useful in diagnosing and managing these diseases. Adapted with permission from davis r, jones js, barocas da, et al. Differential diagnosis for painless hematuria oxford. Hematuria differential diagnosis usmle step 2 cs mnemonics. Urinary frequency is the need to urinate many times during the day, at night nocturia, or both but in normal or lessthannormal volumes. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Nonhematopoietic lesions, such as blastemic wilms tumor, neuroblastoma, and ewing sarcomaperipheral primitive neuroectodermal tumors, also were considered. Pathologic diagnosis % of patients none 53 but %no em igan 30 thin gbm 4 mesangial proliferation 7 fsgs 3 htn, membranous, int nephritis 3 topham et al, q. For the same reason, radiologists seldom include vascular diseases in the differential diagnosis, even though angiography or interventional techniques are useful in diagnosing and. Below is an overview of causes, diagnosis and treatment of bloody urine in cats followed by detailed indepth information about this condition. Things that would give you a clue as to what might have caused the hematuria.
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