Differential Diagnosis for Hematuria

The differential diagnosis for hematuria is broad and can be categorized based on the likelihood and potential impact of missing a diagnosis. Here's a structured approach:

• Single Most Likely Diagnosis
  • Urinary Tract Infection (UTI): This is often the most common cause of hematuria, especially in women. The presence of dysuria, frequency, and urgency alongside hematuria strongly suggests a UTI.
• Other Likely Diagnoses
  • Kidney Stones: Painful hematuria, especially if accompanied by flank pain and radiating pain to the groin, suggests kidney stones.
  • Benign Prostatic Hyperplasia (BPH): In older men, BPH can cause hematuria due to bladder outlet obstruction leading to bladder wall irritation.
  • Cystitis: Interstitial cystitis or other forms of cystitis can cause hematuria, often with symptoms of frequency, urgency, and pelvic pain.
• Do Not Miss Diagnoses
  • Bladder Cancer: Although less common, bladder cancer is a critical diagnosis not to miss. Risk factors include smoking, exposure to certain chemicals, and older age.
  • Kidney Cancer: Similar to bladder cancer, kidney cancer can present with hematuria and is crucial not to miss due to its potential for metastasis.
  • Sickle Cell Disease or Trait: In patients with sickle cell disease or trait, hematuria can occur due to sickling in the kidney. This is particularly important in populations where sickle cell disease is prevalent.
  • Vasculitis (e.g., IgA Nephropathy): Certain forms of vasculitis can cause hematuria and are important to diagnose due to their potential for renal failure and systemic complications.
• Rare Diagnoses
  • Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes, leading to hematuria, hearing loss, and eye abnormalities.
  • Goodpasture Syndrome: An autoimmune disease causing glomerulonephritis and pulmonary hemorrhage, presenting with hematuria and potentially life-threatening if not recognized.
  • Nutcracker Phenomenon: A rare condition where the left renal vein is compressed between the aorta and the superior mesenteric artery, leading to hematuria.

Each of these diagnoses has distinct implications for patient management and outcomes, emphasizing the importance of a thorough evaluation to determine the underlying cause of hematuria.