Hematuria

Hematuria can be gross (i.e., the urine is overtly bloody, smoky, or tea colored) or microscopic. It may be symptomatic or asymptomatic, transient or persistent, and either isolated or associated with proteinuria and other urinary abnormalities.

Classification—

  • Glomerular origin hematuria

Characterized by Brown-colored urine, RBC casts, and dysmorphic RBCs and proteinuria

  • Non-glomerular origin hematuria

Characterized by reddish or pink urine, passage of blood clots, and eumorphic erythrocytes

Causes—-

Glomerular hematuria

  • Thin basement membrane disease
  • Alport syndrome
  • IgA nephropathy
  • Hemolytic-uremic syndrome
  • Postinfectious glomerulonephritis
  • Membranoproliferative glomerulonephritis
  • Lupus nephritis
  • Anaphylactoid purpura (Henoch-Schönlein purpura)

Nonglomerular hematuria

  • Coagulopathy
  • Anatomic abnormalities
  1. Hydronephrosis
  2. Polycystic kidney disease
  3. Vascular malformations
  • Fever
  • Foreign bodies
  • Hypercalciuria/urolithiasis
  • Hyperuricosuria
  • Mechanical trauma (masturbation)
  • Menstruation
  • Sickle cell disease/trait
  • Strenuous exercise
  • Tumors
  • Urinary tract infection
  • Drugs/toxins
  1. Anticoagulants
  2. Cyclophosphamide
  3. Indinavir
  4. NSAID’s
  5. Ritonavir

Symptoms And Signs—

  • Abdominal pain
  • Arthritis
  • Dark-colored urine
  • Dysuria
  • Early-morning periorbital puffiness
  • Edema
  • Fever
  • Frequency
  • Hypertension
  • Joint pains
  • Oliguria
  • Passage of clots in urine
  • Enuresis
  • Skin rashes
  • Throat or skin infection
  • Weight gain

Investigations—–

  • Urine C/E
  • IVU
  • USG
  • Kidney biopsy

Treatment—

                       Asymptomatic hematuria generally does not require treatment. In conditions associated with abnormal clinical, laboratory, or imaging studies, treatment may be necessary, as appropriate, with the primary diagnosis.

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