Differential Diagnosis of Macroscopic Hematuria in Absence of Bladder Pathology
In the absence of bladder pathology, the differential diagnosis for macroscopic hematuria can be categorized as follows:
- Single Most Likely Diagnosis
- Kidney stones (nephrolithiasis): This is a common cause of hematuria, especially if the stones are large enough to cause obstruction or irritation to the urinary tract lining.
- Other Likely Diagnoses
- Urinary tract infections (UTIs): Although more commonly associated with dysuria and frequency, UTIs can cause hematuria, especially in the presence of an upper urinary tract infection (pyelonephritis).
- Glomerulonephritis: An inflammation of the glomeruli, the filtering units of the kidneys, which can be caused by various factors including autoimmune diseases, infections, and vasculitis.
- Renal cell carcinoma: A type of kidney cancer that can cause hematuria, although it is less common than other causes.
- Do Not Miss Diagnoses
- Renal vein thrombosis: A blood clot in the veins that drain blood from the kidneys, which can cause hematuria and is a medical emergency, especially in patients with nephrotic syndrome or other hypercoagulable states.
- Sickle cell disease or trait: Can cause renal complications including hematuria due to sickling of red blood cells within the kidney.
- Vasculitis (e.g., ANCA-associated vasculitis): Inflammation of blood vessels that can affect the kidneys and cause hematuria.
- Rare Diagnoses
- Renal arteriovenous malformations (AVMs): Abnormal connections between arteries and veins in the kidney that can cause hematuria.
- Nutcracker syndrome: Compression of the left renal vein between the aorta and the superior mesenteric artery, which can cause hematuria.
- Loin pain-hematuria syndrome: A rare condition characterized by recurrent episodes of severe flank pain and hematuria, often of unknown cause.
Each of these diagnoses has a distinct set of clinical features and diagnostic approaches. A thorough history, physical examination, laboratory tests (including urinalysis and imaging studies), and sometimes renal biopsy are necessary to determine the underlying cause of macroscopic hematuria in the absence of bladder pathology.