Classification

• According to quantity

• According to the occurrence during voiding

• According to origin

• Macroscopic hematuria (gross hematuria)

• Microscopic hematuria

• Frank blood in urine resulting in visible red/brown discoloration of the urine

• Suggests damage to the kidneys, upper/lower urinary tract

• RBCs are present in the urine sediment but no urine discoloration is visible to the naked eye

• A cutoff of ≥ 3 RBCs per high power field (HPF) is commonly used to define microscopic hematuria

• Can indicate damage to the glomeruli

• However, a number of conditions can cause nonglomerular microscopic hematuria (e.g., UTIs, BPH, urolithiasis, malignancies, menstruation)

• Initial hematuria

• Terminal hematuria

• Total hematuria

• Painless hematuria

• Gross hematuria that occurs at the beginning of micturition and clears by the end of micturition

• Typically suggests urethral damage (e.g., anterior urethral injury, posterior urethral injury)

• Passage of blood or clots in urine during the last part of micturition (when the bladder neck contracts)

• Suggests damage to the bladder neck, prostate, or trigonal area (e.g., benign prostatic hyperplasia, prostatitis)

• Passage of blood or clots throughout the entire micturition

• Suggests damage to the bladder, ureters or kidneys (e.g., urolithiasis, UTI, polycystic kidney disease)

• Passage of blood or clots in urine in the absence of renal or urinary symptoms

• Suggests malignancy (e.g., transitional cell cancer, renal cell carcinoma, prostate cancer)

Gross painless hematuria is the most common clinical finding in urinary tract cancer and should be evaluated with cystoscopy

• Glomerular hematuria

• Non-glomerular hematuria

• Nephritic syndrome

• Isolated hematuria

• Characteristic of glomerulonephritis

• Hematuria with proteinuria is considered glomerulonephritis until proven otherwise.

• the presence of RBCs in the urine with no other urinary abnormalities (e.g., changes in urine protein, serum creatinine, or blood pressure)

• Subdivision:

  • Transient isolated hematuria

  • Persistent isolated hematuria

• Strenuous exercise (i.e., exercise-induced hematuria)

• Infections

• Most likely IgA nephropathy

• Alport syndrome

• Thin basement membrane nephropathy

• Urolithiasis

• Infection

• Malignancy (especially if otherwise asymptomatic)

• Coagulation disorders

• Urinary tract obstruction

• Polycystic kidney disease

• Renal papillary necrosis

• Trauma (e.g., urethral, bladder, ureteral, or renal injury) -> Can be due to pelvic fractures from blunt trauma

• Drugs

• Cystitis

• Urethritis

• Prostatitis

• Urothelial cancer

• Renal cell carcinoma

• Prostate cancer

• In children, nephroblastoma

• Platelet dysfunction

• Hemophilia

• Benign prostatic hyperplasia

• Congenital anomalies

• Sickle cell disease

• Acute pyelonephritis

• Diabetes mellitus

• Analgesics (NSAIDs, in particular, are known to cause renal papillary necrosis)

• Cyclophosphamide, sulfonamides

• Warfarin, heparin