Differential Diagnosis for Hematuria
The differential diagnosis for hematuria is broad and can be categorized based on the likelihood and potential impact of missing a diagnosis.
- 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 blood in the urine.
- Other Likely Diagnoses
- Kidney Stones: Stones in the kidney or ureter can cause bleeding due to the stone's movement and irritation of the urinary tract lining.
- Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland can cause urinary retention and irritation, leading to hematuria, particularly in older men.
- Cystitis: Inflammation of the bladder, which can be due to infection or other causes, leading to bleeding.
- 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 (e.g., IgA Nephropathy): Inflammatory conditions affecting the blood vessels can cause kidney damage 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 present with hematuria.
- Nephrocalcinosis: A condition characterized by the deposition of calcium salts in the renal tissue, which can cause hematuria among other symptoms.
- Renal Artery or Vein Thrombosis: Although rare, these conditions can cause acute kidney injury and hematuria, particularly in individuals with risk factors such as nephrotic syndrome or severe dehydration.
Each of these diagnoses has a different set of risk factors, symptoms, and diagnostic approaches, emphasizing the importance of a thorough medical history, physical examination, and appropriate diagnostic testing to determine the cause of hematuria.