- Normal urine contains < 3 RBCs/HPF
- Microscopic hematuria =
> 3 RBC/HPF in urine.
- Positive Dipstick for blood in urine indicates:
- M/C cause of hematuria is Acute Cystitis
- M/C cause of glomerular hematuria is IgA Nephropathy
- Papillary necrosisis is the cause of hematuria in Diabetics, Sickle cell disease, analgesic abuse, African Americans.
- M/C cause of milky/Cloudy urine is – Phosphaturia
- M/C cause of painless hematuria after age of 50 yrs is – Bladder Cancer
- Pseudohematuria = Seen in ingestion of rifampicin, beet root, phenolpthaline.
Causes of Renal Papillary Necrosis
- Diabetes mellitus
- Urinary tract obstruction
- Analgesic abuse
- Sickle cell hemoglobinopathies
- Renal transplant rejection
- Cirrhosis of the liver
- Dehydration, hypoxia, and jaundice of infants
- Miscellaneous: Renal vein thrombosis, cryoglobulinemia, renal candidiasis, contrast media injection, amyloidosis, calyceal arteritis, necrotizing angiitis, rapidly progressive glomerulonephritis, hypotensive shock, acute pancreatitis
N.B.: Papillary Necrosis is not found in Renal Cell Carcinoma
Differential Diagnosis of Coloured Urine
- Phosphaturia (m/c)
- Anthocyanin in beets and blackberries
- Chronic lead and mercury poisoning
- Phenazopyridine (Pyridium)
- Indicanuria (tryptophan indole metabolites)
- Indigo carmine
- Methylene blue
- IV promethazine (Phenergan)
- Triamterene (Dyrenium)
- Aloe, fava beans, and rhubarb
- Chloroquine and primaquine
- Furazolidone (Furoxone)
- Metronidazole (Flagyl)
- Nitrofurantoin (Furadantin)
- Brown-black Alcaptonuria (homogentisic acid)
- Tyrosinosis (hydroxyphenylpyruvic acid)
- Cascara, senna (laxatives)
- Methocarbamol (Robaxin)
- Methyldopa (Aldomet)
Frequently Asked Questions:
- Etiology of hematuria.
- Differential diagnosis of hematuria.
- What is microscopic hematuria?
- Short notes : painless hematuria.
- Discuss the causes, investigations and management of a case of hematuria.
- A male patient aged 60 years attended surgical OPD with painless hematuria. How will you diagnose and treat the case?
- Essential hematuria = Circular RBC, No Cast, No proteinuria
- Exercise induced hematuria:
- Occurs in long distance runners (>10kms)
- Noted at end of the run.
- Disappears with rest.
- Renal – IgA nephropathy.
- Bladder – Bladder tumor.
In evaluating hematuria, following questions should be asked, and which help the subsequent diagnostic evaluation efficiently:
- Is the hematuria gross or microscopic?
- At what time during urination does the hematuria occur (beginning or end of stream or during entire stream)?
- Is the hematuria associated with pain?
- Is the patient passing clots?
- If the patient is passing clots, do the clots have a specific shape?
- Vitals: Pallor / BP / RR / HR / Temp / Urine output
- Renal lump
- Palpable bladder
- Renal angle tenderness (Infective origin)
- Any bruise in the flank after trauma.
- Evaluate prostatic condition.
- pH (normal pH = 5.5 – 6.5):
- if alkaline indicates infection
- sterile pyuria in acidic urine
- Causes are TB, Stone, Malignancy, Interstitial nephritis, ↑IL-6 and IL-8.
- Culture: To detect uro-pathogens.
USG of KUB Region:
- Mainly to detect any
- Prostatic volume
- Post void residual
- Any stone disease
- Cystoscopy should be performed as soon as possible, because frequently the source of bleeding can be readily identified.
- All patients with hematuria, except young women (<40 years) with acute bacterial hemorrhagic cystitis, should undergo urologic evaluation.
- Older women and men who present with hematuria and irritative voiding symptoms may have cystitis secondary to infection arising in a necrotic bladder tumor or, more commonly, flat carcinoma in situ of the bladder.