Causes of Hematuria - Differential Diagnosis Algorithm

Red blood cells on urine microscopy. Must exclude false positives from myoglobinuria, beet, drugs (pyridium, phenytoin, rifampin, nitrofurantoin), or menstruation

Extraglomerular - Upper Tract (above bladder)

     • Vascular

     • Tubulolnterstitial

     • Calculi 

     • Neoplasm/Cyst

Extraglomerular - Lower Tract (bladder & below)

     • Trauma

     • Neoplasm

     • BPH

     • Calculi

Glomerular (Dysmorphic RBCs and/or RBC casts)

 - Isolated Hematuria with benign sediment (injury to epithelial side of glomerular capillary wall)

     • IgA nephropathy

     • Thin GBM disease

     • Hereditary nephritis (Alport's)

 - Isolated Hematuria with active sediment (injury to the endothelial side of glomerular capillary wall)

     • Anti-GBM antibodies

     • Immune-complex deposition (IgA, post-strep, lupus)

     • Pauci-immune disease (Granulomatosis with polyangiitis/microscopic polyangiitis)

 - Hematuria with active sediment and >3.5g/day (nephrotic range) proteinuria (injury to both endothelial and epithelial capillary wall)

     • Membranoproliferative glomerulonephritis

     • Lupus glomerulonephritis

     • Post-Infectious glomerulonephritis



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