Hematuria - Differential Diagnosis Framework



Gross Hematuria: Red/Dark urine

 • 1ml blood/liter urine can induce color change

 • Gross hematuria + clots ➔ Lower Urinary tract source

 • Hematuria: 3 or more RBC/HPF spun urine sediment



Microscopic Hematuria:

 • Detectable by examination of urine sediment by microscopy (Urinalysis or dipstick)



Glomerular Hematuria:

 • Immune mediated injury

 • Noninflammatory glomerulopathies

 • Causes of Glomerular Bleeding

	- IgA nephropathy

	- Thin basement membrane disease

	- Alport syndrome

	- Mesangioproliferative GN without IgA deposits

	- Post-infectious GN

	- Loin pain hematuria syndrome:

		• Flank pain + gross or microscopic hematuria

 • Signs of glomerular hematuria:

	- RBC casts → Diagnostic of GN or vasculitis

 	- Dysmorphic RBC

	- Brown urine

	- Proteinuria → Suggestive of glomerular disease



Renal Causes of Hematuria:

 • Pyelonephritis

 • Hydronephrosis

 • Malignant HTN

 • Renal vein thrombosis

 • Renal artery embolism

 • AVM

 • Papillary necrosis (Sickle cell)

 • Renal Mass



Ureteral Causes of Hematuria:

 • Stone

 • Stricture

 • Malignancy

 • Fistula

 • Post-procedural

 • Nutcracker syndrome:

	- Compression of left renal vein between aorta and SMA

	- Can cause microscopic and gross hematuria



Bladder Causes of Hematuria:

 • Malignancy

 • Cystitis

 • Bladder stones/polyps

 • Radiation

 • Rapid decompression

 • Diverticulum



Urethra/Prostate Causes of Hematuria:

 • Urethritis

 • Urethral diverticulum

 • Traumatic catheterization

 • BPH

 • Prostate cancer

 • TURP/Biopsy



Renal/Ureter/Bladder (Upper and Lower urinary tract) Causes of Hematuria:

 • Infection (Viral/Bacterial)

 • TB

 • Schistosomiasis

 • Urolithiasis

 • Malignancy

 • Trauma

 • Intervention

 • Exercise induced bleeding

 • Anticoagulation



Pseudohematuria:

 • GI bleed

 • Menstruation/Postpartum

 • Drugs: Pyridium, Phenytoin, Rifampin

 • Beets

 • Pigmenturia



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