II. Background
- Consider non-urine source (e.g. vagina or Rectum)
III. Causes: Most common of adult Hematuria by history
- Age
- Age <20 years
- Age 20-40 years
- Ureterolithiasis
- Urinary Tract Infection
- Urinary Tract Cancer (less common)
- Age 40-60 years
- Urinary tract cancer (up to 10% of cases)
- Ureterolithiasis
- Urinary Tract Infection
- Age >60 years
- Urinary tract cancer (up to 10% of cases)
- Prostatic Disease (e.g. Benign Prostate Hyperplasia)
- Timing
- Gross Hematuria on initiating urine stream
- Gross Hematuria at end or urination
- Prostate source
- Gross Hematuria throughout urination
- Renal Source
- Cyclical Gross Hematuria
- Consider Endometriosis
-
Hematuria with pain
- Nephrolithiasis
- Renal Vein Thrombosis
- Renal Artery Occlusion
- Renal Cancer
-
Hematuria with Dysuria
- Hemorrhagic cystitis (Urinary Tract Infection)
- Prostatic infection
- Bladder stones
-
Hematuria with history of Trauma
- Urethral disruption (seen in pubic Fracture)
- Bladder injury (seen in Pelvic Fracture)
- Renal Laceration or rupture
-
Hematuria based on Urine Color
- Brown Urine: Gross Hematuria (or other causes of Brown Urine)
- Urine clots: Post-renal source of bleeding
IV. Causes: Asymptomatic Microscopic Hematuria by Incidence
- Benign essential Hematuria (37%)
- Benign Prostatic Hyperplasia (24%)
- Urethral Infection (21%)
- Urinary Tract Infection (7%)
- Nephrolithiasis (4%)
- Urethral calculus (2%)
- Bladder tumor (2%)
- Renal Cyst (1.5%)
- Renal tumor (0.5%)
V. Causes: Most important to rule-out (cancer and aneurysm)
VI. Causes: Important to treat
-
Bladder and Urethra Disease
- Urinary Tract Infection
- Acute Cystitis
- Pyelonephritis
- Mycobacterial cystitis
- Bladder calculus
- Urethral Stricture or meatal stenosis
- Bladder papilloma
- Urinary Tract Infection
-
Kidney and ureter disease
- Renal parenchymal disease
- Ureteropelvic junction obstruction
- Nephrolithiasis
- Vesicoureteral reflux
- Hydronephrosis
- Renal Artery Stenosis
- Renal vein thrombosis
-
Prostate Disease
- Symptomatic Benign Prostatic Hyperplasia
- Prostatitis
VII. Causes: Important to Observe
-
Prostate Disease
- Asymptomatic Benign Prostatic Hyperplasia
-
Bladder and Urethra Disease
- Radiation cystitis
- Bladder diverticulum
- Bladder neck contracture
- Interstitial Cystitis
- Cystocele
- Neurogenic Bladder
- Eosinophilic cystitis
- Phimosis
-
Kidney and ureter disease
- Atrophic Kidney
- Papillary necrosis
- Renal Arteriovenous Fistula
- Renal Contusion or Trauma
- Polycystic Kidney Disease
- Ureterocele
- Interstitial Nephritis (Gold, Penicillamine, NSAIDs)
- Glomerular Causes - Primary
- See Glomerulonephritis Causes
- Focal Segmental Glomerulosclerosis
- Goodpasture Syndrome
- Henoch-Schonlein Purpura
- Mesangial proliferative Glomerulonephritis
- Postinfectious Glomerulonephritis
- Rapidly Progressive Glomerulonephritis
- IgA Nephropathy (Berger Disease, associated with infectious disease)
- Glomerular Causes - Secondary
- Glomerular Causes - Familial
- Fabry Disease
- Alport's Hereditary Nephritis (Alport Syndrome)
- Nail-Patella Syndrome
- Thin glomerular basement membrane disease (50%)
VIII. Causes: Benign
IX. Causes: Systemic
- Cardiovascular and hematologic causes
- Rheumatologic Causes
- Medications
- See Medication Causes of Hematuria
- Interstitial Nephritis (Gold, Penicillamine, NSAIDs)
- Warfarin (if associated with urologic anomaly)
- Infections
X. References
- Swadron (2019) CCME Emergency Board Review, accessed 5/18/2019
- Grossfield (1998) Urol Clin North Am 25:661-76 [PubMed]
