Differential Diagnosis of Hematuria

The differential diagnosis of hematuria can be organized into several categories based on the likelihood and potential impact of each condition.

• Single Most Likely Diagnosis
  • Urinary Tract Infection (UTI): This is often the most common cause of hematuria, especially in women. UTIs can cause inflammation and irritation of the bladder and urinary tract, leading to blood in the urine.
• Other Likely Diagnoses
  • Kidney Stones: Stones in the kidney or ureter can cause bleeding due to irritation and obstruction of the urinary tract.
  • Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland can cause urinary retention and irritation, leading to hematuria.
  • Cystitis: Inflammation of the bladder, often due to infection or other irritants, can cause hematuria.
• Do Not Miss Diagnoses
  • Bladder Cancer: Although less common, bladder cancer is a critical diagnosis to consider, as it can present with painless hematuria.
  • Kidney Cancer: Similar to bladder cancer, kidney cancer can cause hematuria and is crucial not to miss due to its potential for severe outcomes if not treated early.
  • Trauma: Physical injury to the urinary tract, such as from a car accident or fall, can cause hematuria and is essential to identify promptly.
• Rare Diagnoses
  • Alport Syndrome: A genetic disorder affecting the type IV collagen in the body, leading to kidney disease and sometimes hematuria.
  • Goodpasture Syndrome: An autoimmune disease causing inflammation in the kidneys and lungs, which can present with hematuria.
  • Sickle Cell Disease: A genetic disorder that can cause sickling of red blood cells in the kidneys, leading to hematuria.
  • Vasculitis: Inflammation of the blood vessels, which can affect the kidneys and cause hematuria.

Each of these diagnoses has a different set of risk factors, symptoms, and diagnostic approaches. A thorough medical history, physical examination, and appropriate diagnostic tests (such as urinalysis, imaging studies, and biopsy) are necessary to determine the underlying cause of hematuria in a patient.