Differential Diagnosis for Painless Gross Hematuria
Single Most Likely Diagnosis
- Bladder Cancer: This is often the first consideration in adults presenting with painless gross hematuria, especially in smokers or those with a history of exposure to certain chemicals. Bladder cancer can cause bleeding into the urinary tract without significant pain.
Other Likely Diagnoses
- Kidney Stones: Although kidney stones often cause painful hematuria, some stones may not cause significant pain, especially if they are small and not obstructing the urinary tract.
- Urinary Tract Infections (UTIs): Certain UTIs, particularly those involving the kidneys (pyelonephritis), can cause hematuria without significant pain, especially in older adults or those with compromised immune systems.
- Benign Prostatic Hyperplasia (BPH): In men, an enlarged prostate can cause urinary retention, leading to bleeding into the urine, which may be painless.
Do Not Miss Diagnoses
- Trauma: Even if the patient does not report a history of trauma, it's crucial to consider the possibility of internal injury that could be causing hematuria. This is especially important in cases where the mechanism of injury could have caused internal damage without obvious external signs.
- Sickle Cell Disease or Trait: Individuals with sickle cell disease or trait can experience hematuria due to sickling in the kidney, which may be painless.
- Renal Artery Aneurysm or Arteriovenous Malformation (AVM): These vascular abnormalities can cause hematuria and are critical to diagnose due to their potential for severe complications, including rupture.
Rare Diagnoses
- Goodpasture Syndrome: A rare autoimmune disease that can cause hematuria due to antibodies attacking the kidneys and lungs.
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes, leading to hematuria and progressive kidney disease.
- Nephrocalcinosis: A condition characterized by the deposition of calcium salts in the renal tissue, which can cause hematuria among other symptoms.
- Renal Tubular Acidosis (RTA): A group of disorders that affect the kidneys' ability to regulate acid levels, potentially leading to hematuria and other electrolyte imbalances.