Hematuria is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Gross (visible) or microscopic (nonvisible) blood in the urine
  • Symptomatic or asymptomatic

Epidemiology

Prevalence
  • Microscopic hematuria in school-aged children: 0.4–4%
  • Microscopic hematuria in asymptomatic adults varies from 0.9% to 17%, depending on population.

Etiology and Pathophysiology

  • Trauma
    • Exercise-induced (resolves within 24 hours of ceasing activity)
    • Abdominal trauma or pelvic fracture with renal, bladder, or ureteral injury
    • Iatrogenic from abdominal or pelvic surgery; chronic indwelling catheters
    • Foreign body, physical/sexual abuse
  • Neoplasms
    • Urologic malignancies
    • Benign tumors
    • Endometriosis of the urinary tract (suspect in females with cyclic hematuria)
  • Inflammatory/infectious causes
    • UTI: most common cause of hematuria in adults
    • Renal diseases: radiation nephritis and cystitis, acute/chronic tubulointerstitial nephritis (due to drugs, infections, systemic disease)
    • Glomerular disease
      • Goodpasture syndrome (antiglomerular basement membrane disease; autoimmune; associated pulmonary hemorrhage)
      • IgA nephropathy
      • Lupus nephritis
      • Henoch-Schönlein purpura
      • Membranoproliferative, poststreptococcal, or rapidly progressive glomerulonephritis (GN)
      • Wegener granulomatosis
    • Endocarditis/visceral abscesses
    • Other infections: schistosomiasis, TB, syphilis
  • Metabolic causes
    • Stones (85% have hematuria)
      • Hypercalciuria: a common cause of both gross and microscopic hematuria in children
      • Hyperuricosuria
  • Congenital/familial causes
    • Cystic disease: polycystic, solitary renal cyst
    • Benign familial hematuria or thin basement membrane nephropathy (autosomal dominant)
    • Alport syndrome (X-linked in 85%; hematuria, proteinuria, hearing loss, corneal abnormalities)
    • Fabry disease (X-linked recessive inborn error of metabolism; vascular kidney disease)
    • Nail–patella syndrome (autosomal dominant; nail and patella hypoplasia; hematuria in 33%)
    • Renal tubular acidosis type 1 (autosomal dominant or autoimmune)
  • Hematologic causes
    • Bleeding dyscrasias (e.g., hemophilia)
    • Sickle cell anemia/trait (renal papillary necrosis)
  • Vascular causes
    • Hemangioma
    • Arteriovenous malformations (rare)
    • Nutcracker syndrome: compression of left renal vein and subsequent renal parenchymal congestion
    • Renal artery/vein thrombosis
    • Arterial emboli to kidney
  • Chemical causes
    • Aminoglycosides, cyclosporine, analgesics, oral contraceptives, Chinese herbs
  • Obstruction
    • Strictures or posterior urethral valves
    • Hydronephrosis from any cause
    • Benign prostatic hyperplasia: Rule out 25 RBCs/hpf—other causes of hematuria.
  • Other causes: loin pain hematuria (most often in young women on oral contraceptives)

Risk Factors

  • Smoking
  • Occupational exposures (dyes, rubber, or tire manufacturing)
  • Analgesic abuse (e.g., phenacetin)
  • Medications (e.g., cyclophosphamide)
  • Pelvic irradiation
  • Chronic infection, especially with calculi
  • Recent upper respiratory tract infection
  • Positive family history of renal diseases (stones, GN)
  • Underlying primary renal disorder
  • Chronic indwelling foreign body

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hematuria ID - 116258 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116258/all/Hematuria PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -