From the Research
Introduction to Hematuria and Proteinuria
Hematuria and proteinuria are common findings in clinical practice, and their evaluation is crucial to determine the underlying cause and provide appropriate management.
Definition and Prevalence
Hematuria is defined as the presence of red blood cells in the urine, and proteinuria is defined as the presence of excess protein in the urine.
Evaluation of Hematuria and Proteinuria
The evaluation of hematuria and proteinuria should take into account the patient's age, medical history, family history, concurrent symptoms, physical examination findings, and basic laboratory test results 1.
Serologies to be Ordered
To evaluate hematuria and subnephrotic range proteinuria, the following serologies should be ordered:
- Antinuclear antibody (ANA) to rule out systemic lupus erythematosus
- Anti-glomerular basement membrane (anti-GBM) antibody to rule out Goodpasture's syndrome
- Antineutrophil cytoplasmic antibody (ANCA) to rule out vasculitis
- Complement levels (C3 and C4) to rule out complement-mediated glomerulonephritis
- Hepatitis B and C serologies to rule out viral-associated glomerulonephritis
Differential Diagnosis
The differential diagnosis for hematuria and proteinuria is extensive, but the presence or absence of proteinuria is a key differentiating feature 2.
Key Considerations
- Patients with significant proteinuria deserve a rapid evaluation and early referral to a nephrologist
- Patients with asymptomatic microscopic hematuria without proteinuria can be followed with a step-wise evaluation
- The presence of both hematuria and proteinuria significantly increases the likelihood of significant renal disease and should prompt a referral to a specialist 3
Treatment and Management
The treatment and management of hematuria and proteinuria depend on the underlying cause and may involve medications, lifestyle modifications, and referral to a specialist.
Caveats
- Routine screening for proteinuria is not recommended in the general population, but it is recommended for high-risk patients, such as those with diabetes and hypertension 1
- Patients with persistent hematuria and concomitant proteinuria should be referred to a nephrology subspecialist for further evaluation and management 1