Definition,causes of hemenegative red urine,differential diagnosis,non glomerular,isolated hematuria

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This lecture was conducted during the Nephrology
Unit Grand Ground by Medical Student under
Nephrology Division under the supervision and
administration of Prof. Jamal Al Wakeel, Head of
Nephrology Unit, Department of Medicine and Dr.
Abdulkareem Al Suwaida, Chairman of Department of
Medicine and Nephrology Consultant. Nephrology
Division is not responsible for the content of
the presentation for it is intended for learning
and /or education purpose only.
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Hematuria

• Presented By
• Abdulmajeed Alahmari
• Medical Student
• 2009

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Definition

• Bloody urine
• Gross hematuria
• Microscopic hematuria
• 3 or more RBCs per high power field in spun
  urine sediment

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(No Transcript)
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Causes of heme-negative red urine
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Differential Diagnosis

• Glomerular
• ARF
• primary nephritis (post streptococcal
  glomerulonephritis , Ig A nephropathy , Anti-GBM
  disease)
• 2nd nephritis (SLE, goodpastures syndrome, ANCA
  related vasculitis)
• Alports syndrome (hereditary nephritis)
• thin basement membrane nephropathy (benign
  familial hematuria)

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Non glomerular

• Renal Causes
• malignancy
• vascular disease
• sickle cell trait/disease, papillary necrosis
• infection (pyelonephritis, TB, CMV, EBV)
• hypercalciuria
• hereditary disease (polycystic kidney disease )

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Non glomerular

• Non-renal causes
• malignancy (prostate, ureter, bladder)
• BPH
• Nephrolithiasis
• Coagulopathy
• Trauma

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• Isolated hematuria
• No other urinary abnormalities
• No renal insufficiency
• No evidence for systemic disease

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Cuases of Isolated hematuria

• Glomerular
• - Benign Recurrent or Persistent Hematuria
• 1.Sporadic
• 2.Familial
• - IgA Nephropathy
• - Alport syndrome
• - PSAGN
• Non-glomerular
• - Idiopathic Hypercalciuria
• - Cystic Kidneys
• - Urinary Tract obstruction
• - Tumors
• - Trauma

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Initial Evaluation

• Thorough history and physical exam
• Any clues that point to particular diagnosis?
• Is hematuria transient or persistent?
• Repeat UA in a few days to determine
• Is it glomerular or extraglomerular bleeding?

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Glomerular vs. Extraglomerular

• Urine is red, smoky brown or coca-cola
• Clots absent
• Proteinuria gt500 mg/day
• Dysmorphic RBCs
• RBC casts are present

• Red or pink urine
• Clots may be present
• lt500 mg/day proteinuria
• Normal RBC
• RBC casts may be present

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Dysmorphic erythrocytes suggest hematuria of
glomerular origin.
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• History
• Age
• Time of hematuria
• Abdominal or flank pain
• Dysuria, frequency, urgency
• Trauma
• Strenuous exercise
• Menstruation
• Recent URI/ sore throat
• Skin rashes
• Joint pains/swellings

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Drug history (analgesics, NSAID, chemotherapy
agents) Coagulopathy Family history of PCKD or
Alports syndrome
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Physical Examination

• Vital signs, esp. BP
• Flank tenderness
• Edema
• Cardiac murmur
• Hemoptysis
• Suprapubic discomfort
• Genitourinary exam

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Lab Data

• Urinalysis ( bacteria , pH, protein,, cast )
• Glomerular RBC casts, RBC dysmorphism,
• Non-glomerular Intact RBC
• U/C, BUN, Cre, CBC
• Anticoagulation study
• Immunologic profiles

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• Non-glomerular causes
• CT, renal US, and/or IVP to search for
  lesions in the kidney, collecting system,
  ureters, and bladder
• Urine cytology if increased risk for
  urothelial cancers
• Consider a referral to urology for
  cystoscopy, especially for pt at risk of
  malignancies

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• Thank you