Diagnostics

• Personal and family history

• Medication

• Travel history

• Additional urinary symptoms

• Additional non-urinary symptoms

• Kidney disease (e.g., polycystic kidney disease) or renal failure

• Sickle cell disease (Can cause papillary necrosis, which can lead to hematuria)

• anticoagulants, nephrotoxic agents

• especially areas endemic for Schistosoma haematobium or tuberculosis

• Dysuria (pain, burning, urge to void) -> most common in UTI

• Flank pain (In the context of hematuria, unilateral flank pain is typically due to ureteral obstruction (e.g., calculus, blood clot))

• Difficulty voiding (urine retention, straining, intermittent stream, dribbling) -> Indicates some kind of urethral obstruction. In men, BPH is most common, but other causes, like prostate or bladder cancer, should be considered as well.

• Recent or current upper respiratory infection (May indicate vasculitis and glomerulonephritis)

• Skin changes (e.g., edema, rashes, petechiae, purpura) -> in combination with hematuria, skin changes indicate a systemic process rather than a focal lesion (e.g., vasculitis)

• Menstruational abnormalities ->Vaginal bleeding can contaminate the urine and cause false-positive results

Urinalysis

• Urine dipstick

• Urine sediment

• Urine culture

detects heme in urine (high sensitivity, low specificity)

• A negative result for heme on urine dipstick makes hematuria very unlikely.

• A positive result for heme does not confirm hematuria because the test does not distinguish between the presence of RBCs, hemoglobin, and myoglobin.

• If additional proteinuria is present, evaluate for glomerular diseases.

Confirm hematuria with microscopy (≥ 3 RBCs/HPF)

When hematuria (red or brown urine, positive urine dipstick) is suspected, the presence of RBCs must be confirmed with microscopic analysis of the urine sediment.

Evaluate for glomerular diseases

Evaluate for nonglomerular causes (e.g., coagulation disorders, kidney stones, malignancy).

indicates hemoglobinuria or myoglobinuria

if clinical signs of infection exist or dipstick is positive for WBCs (pyuria) and/or leukocyte esterase

• Often normal (microscopic hematuria)

• Sometimes light red (Macrohematuria can occur in autoimmune diseases, vasculitides, poststreptococcal glomerulonephritis, and IgA nephropathy)

Dark red or pink urine (Gross hematuria)

• Acanthocytes (dysmorphic)

Normal (isomorphic)

• Sometimes

NO

NO

Sometimes

• > 500 mg/day

• Mostly albumin (Glomerular proteinuria can cause the heaviest degree of proteinuria, reaching > 3.5 g/day (also referred to as nephrotic range proteinuria))

• < 500 mg/day