Some Common Specific Causes of Hematuria
Cause | Suggestive Findings | Diagnostic Approach* |
|---|---|---|
Infection | Urinary irritative symptoms, with or without fever | Urinalysis and culture |
Sudden-onset, usually colicky, severe flank or abdominal pain, sometimes with vomiting | Abdominal CT without contrast or ultrasonography of the abdomen | |
Glomerular disease (numerous forms) | In many patients, hypertension, edema, or both Possibly red or dark (cola-colored) urine Sometimes preceding infection, family history of renal disorders, or systemic rheumatic disease Usually proteinuria (except with thin basement membrane disease and mild IgA nephropathy) | Urinalysis Urine sediment examination for RBC cast and dysmorphic RBCs Serologic tests |
Mainly in patients > Sometimes voiding symptoms with bladder cancer Often systemic symptoms with renal cell carcinoma | In all patients without another obvious cause, cystoscopy and possible bladder biopsy; if prostate cancer is suspected, PSA and possibly prostate biopsy | |
Mainly in patients > 50 Often, urinary obstructive symptoms Palpably enlarged prostate | PSA Measurement of postvoid residual urine volume Ultrasonography of pelvis | |
Mainly in patients > 50 Often, urinary irritative and obstructive symptoms Painful, tender prostate with acute infection | Clinical evaluation Sometimes transrectal ultrasonography or cystoscopy | |
Chronic flank or abdominal pain Large kidneys | Ultrasonography or noncontrast CT/MRI of the abdomen | |
Renal papillary infarction or necrosis | Often in people with sickle cell disease or trait Sometimes heavy analgesic use (analgesic nephropathy) | Sometimes sickle cell preparation and Hb electrophoresis |
Hematuria coinciding with menses | Clinical evaluation | |
Trauma (blunt or penetrating) | Usually, presentation as injury rather than as hematuria | CT of the abdomen and pelvis |
Loin pain–hematuria syndrome | Flank pain Hematuria | Urinalysis and CT |
Nutcracker syndrome | Hematuria Left testicular pain Varicocele | CT angiography |
* All patients require urinalysis and evaluation of renal function; older patients require imaging of kidneys and pelvis. | ||
Hb = hemoglobin; PSA = prostate-specific antigen; RBC = red blood cell. | ||