From the Research
Introduction to Hematuria
Hematuria is a clinical manifestation of various diseases affecting the urinary system, presenting as either macroscopic or microscopic hematuria due to glomerular or non-glomerular disorders 1. It is essential to differentiate between these two types, as the underlying causes and management strategies may vary significantly.
Classification and Diagnosis
Hematuria can be classified as either gross (macroscopic) or microscopic, with the risk of malignancy being greater than 10% in cases of gross hematuria, warranting prompt urologic referral 2. Microscopic hematuria, on the other hand, often has benign causes, such as urinary tract infections, benign prostatic hyperplasia, and urinary calculi. A thorough history, physical examination, and urine microscopy are crucial in determining the potential causes and assessing risk factors for malignancy.
Differential Diagnosis
The differential diagnosis of hematuria includes:
- Intrinsic renal disease
- Urinary tract infections
- Benign prostatic hyperplasia
- Urinary calculi
- Vascular diseases involving the upper urinary tract, although rare 3
- Malignancy
Evaluation and Management
Evaluation of hematuria involves:
- Urine microscopy to differentiate glomerular from non-glomerular hematuria
- Laboratory tests to rule out intrinsic renal disease
- Imaging of the urinary tract
- Referral to nephrology and urology subspecialists, if necessary There is no specific treatment to resolve or prevent hematuria; resolution usually occurs with appropriate management of the underlying disorder 1. Persistent microscopic hematuria indicates the presence of a renal disease that warrants close monitoring and evaluation.
Treatment and Management Considerations
Treatment of hematuria focuses on addressing the underlying cause. In some cases, such as vascular diseases, management options may include endovascular techniques 3. It is essential to recognize drug-induced hematuria, particularly secondary to analgesic use, and to consider this in routine clinical practice 1.
Caveats and Considerations
- Hematuria may not always represent an underlying disease, especially in young adult patients with transient hematuria 4.
- Prompt referral to a pediatric nephrologist is indicated in situations where hematuria does not resolve within 2 weeks of onset, or when a renal biopsy, specific urine biochemistry testing, or imaging studies are necessary 1.