From the Guidelines
Hematuria, proteinuria, and leukocyturia without a urinary tract infection can be caused by glomerulonephritis, a type of kidney disease that involves inflammation of the glomeruli, which are the filtering units of the kidneys 1.
Possible Causes
- Glomerulonephritis can be caused by a variety of factors, including infections, autoimmune disorders, and vasculitis 1.
- Renal parenchymal disease, such as IgA nephropathy or Alport syndrome, can also cause hematuria, proteinuria, and leukocyturia 1.
- Interstitial renal disease, such as drug-induced interstitial disease or analgesic nephropathy, may be associated with hematuria 1.
- HIV-associated nephropathy (HIVAN) can cause proteinuria, hematuria, and leukocyturia in HIV-infected patients 1.
Key Findings
- The presence of red blood cell casts, deformed red blood cells, and proteinuria in the urine suggests a glomerular source of hematuria 1.
- Sterile leukocyturia can be a sign of renal disease, such as HIVAN or interstitial nephritis 1.
- A thorough history, physical examination, urinalysis, and serologic testing are essential in evaluating patients with hematuria, proteinuria, and leukocyturia 1.
Evaluation and Management
- Renal biopsy may be necessary to diagnose the underlying cause of hematuria, proteinuria, and leukocyturia, especially in patients with suspected glomerulonephritis or renal parenchymal disease 1.
- Imaging studies, such as ultrasound, may be useful in evaluating the size and structure of the kidneys, but are not always necessary in the initial evaluation of hematuria, proteinuria, and leukocyturia 1.
From the Research
Causes of Hematuria, Proteinuria, and Leukocyturia
- Hematuria can be caused by renal or extrarenal factors, including vascular disease, renal vein thrombosis, urinary tract obstruction, acute tubular interstitial nephritis, primary and secondary glomerulopathies, urinary tract infection, and urolithiasis 2
- Proteinuria can be indicative of underlying renal disease, and its presence along with hematuria may suggest a glomerulopathy 2, 3
- Leukocyturia can be caused by urinary tract infection, but its presence without significant bacteriuria requires further diagnostic evaluation 4
Diagnostic Approach
- The diagnostic approach for hematuria, proteinuria, and leukocyturia emphasizes the importance of clinical history, familial background, and circumstances of presentation 2
- Urine cultures, intravenous pyelogram, and voiding cystogram may be required to rule out urinary tract infections and urological abnormalities 2, 5
- Blood clotting tests, platelet count, and RBC morphology may be required to rule out hematological disorders 2
- Renal biopsy may be necessary to distinguish between different types of glomerulopathies and other renal diseases 2