Differential Diagnosis for Hematuria

The presence of blood in the urine, or hematuria, can be caused by a variety of conditions affecting the kidneys, ureters, bladder, or urethra. Here's a categorized differential diagnosis for hematuria:

• 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 bleeding.
• Other Likely Diagnoses
  • Kidney Stones: Stones in the kidney or ureter can cause bleeding due to the irritation and damage they inflict on the urinary tract lining.
  • Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland can lead to urinary retention and irritation, potentially causing hematuria.
  • Cystitis: Inflammation of the bladder, which can be due to infection or other causes, can lead to hematuria.
• Do Not Miss Diagnoses
  • Bladder Cancer: Although less common, bladder cancer is a critical diagnosis not to miss, as it can present with painless hematuria.
  • Kidney Cancer: Similar to bladder cancer, kidney cancer can cause hematuria and is crucial to diagnose early for effective treatment.
  • Sickle Cell Disease or Trait: In individuals with sickle cell disease or trait, hematuria can occur due to sickling in the low-oxygen environment of the kidney medulla.
  • Vasculitis: Conditions like IgA vasculitis can cause kidney inflammation and hematuria.
• Rare Diagnoses
  • Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, leading to hematuria, hearing loss, and eye abnormalities.
  • Goodpasture Syndrome: An autoimmune disease causing inflammation in the kidneys and lungs, which can lead to hematuria.
  • Nephrocalcinosis: A condition characterized by the deposition of calcium salts in the renal tissue, which can cause hematuria among other symptoms.
  • Arteriovenous Malformation (AVM): A rare vascular anomaly that can cause hematuria due to abnormal connections between arteries and veins in the kidney or bladder.

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 cystoscopy) are essential for determining the underlying cause of hematuria.