Differential diagnosis of hematuria

Question 1

What is hematuria ?

Answer 1

• presence of RBCs in the urine

Question 2

Define microscopic hematuria:

Answer 2

• > 3-10 RBCs per HPF

Non visible by the eye, but detected by complementary exams.

Question 3

Define macroscopic hematuria:

Answer 3

• > even 1 mL in 1000 mL

Visible with your own eyes

Question 4

Types of RBCs in urine:

Answer 4

• Isomorphic - originate in the urinary tract
• Dysmorphic (acanthocytes) - originate in the glomeruli
• RBC casts - indicate glomerulonephritis

Question 5

Different characteristics found in certain hematuria: the most frequent causes

Answer 5

• UTI (infection urinaires), especially Schistosomiasis (bilharziose), parasitic infection
• Renal colic (Colique néphrétique), an abdominal pain caused by kidney stones
• bladder tumors (tumeurs vésicales) -> highly related to smoking

Question 6

Different characteristics found in certain hematuria: renal stones

Answer 6

• > reveals urological origin

- painful

Question 7

Different characteristics found in certain hematuria: pelvic or lumbar pain

Answer 7

• > reveals urological blockade or inflammation

- nephrological pathologies are never painful

Question 8

Different characteristics found in certain hematuria: the 3 glasses test

Answer 8

Patient urinates in 3 different classes

• initial hematuria: low level bleeding -> urethral or prostatic
• terminal hematuria: bleeding more likely located in the bladder
• total hematuria: bleeding in the kidneys or ureters

Question 9

Diagnostic tools to detect hematuria:

Answer 9

• dipstick

- cytobacteriological urine test

Question 10

Microscopic hematuria: the different possible etiologies

Answer 10

• UTI -> perform urine culture
• Prostatic origins -> look for prostate-specific antigen testing
• Glomerulonephritis, often associated with fever, a recent infection like streptococcus
• Cystitis
• Nephrolithiasis -> flank pain or groin pain
• Trauma

Question 11

Macroscopic hematuria: the different possible etiologies

Answer 11

• Painless gross hematuria in older patient -> high risk of malignancy -> perform urine cytology
• IgA nephropathy, associated with upper respitaroy tract infection. Urinalysis shows -> RBC casts + mild proteinuria (nephritic syndrome)
• Kidney neoplasms: patient may experience flank fullness, history of dialysis, smoking or renal cell carcinoma, polycystic kidney disease and weight loss.
• Pyelonephritis, also see flank pain, fever, chills, nausea, vomiting, abdominal pain, suprapubic pain
• Prostate cancer, older men, weight loss, obstructive voiding (peeing)