Hematuria differential diagnosis: Difference between revisions

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| rowspan="5" |Type of hematuria
| rowspan="5" |Type of hematuria
| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="9" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! colspan="8" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
| colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
Line 23: Line 23:
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="2" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
Line 34: Line 34:
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pitting edema
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pitting edema
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Biomarkers
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
Line 44: Line 41:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Oliguria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Oliguria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Light microscopy
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Light microscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electron microscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunoflourescence pattern
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunoflourescence pattern
|-
|-
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|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| colspan="2" style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 75: Line 69:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Alport syndrome|Hereditary nephritis (Alport syndrome)]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Alport syndrome|Hereditary nephritis (Alport syndrome)]]
|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Cataract
* Cataract


* Hearing loss
* Hearing loss
| style="background: #F5F5F5; padding: 5px;" |
| colspan="2" style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Pyuria]]
* [[Pyuria]]
* Red cell [[casts]]
* Red cell [[casts]]
* Cylindrical [[casts]]
* Cylindrical [[casts]]
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Renal Biopsy
| style="background: #F5F5F5; padding: 5px;" |Renal Biopsy
* Irregularly thin and attenuated GBM
* Irregularly thin and attenuated GBM
Line 107: Line 99:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Poststreptococcal glomerulonephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Poststreptococcal glomerulonephritis]]
|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 130: Line 121:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[MPGN|Mesangioproliferative glomerulonephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[MPGN|Mesangioproliferative glomerulonephritis]]
|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 153: Line 143:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Focal segmental glomerulosclerosis|Focal segmental glomerular sclerosis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Focal segmental glomerulosclerosis|Focal segmental glomerular sclerosis]]
|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 176: Line 165:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Rapidly progressive glomerulonephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Rapidly progressive glomerulonephritis]]
|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 199: Line 187:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lupus nephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lupus nephritis]]
|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 222: Line 209:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thin basement membrane disease]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thin basement membrane disease]]
|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fabry's disease|Fabry disease]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fabry's disease|Fabry disease]]
|Microscopic
|Microscopic
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 269: Line 254:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal papillary necrosis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal papillary necrosis]]
|Gross
|Gross
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 292: Line 276:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Interstitial nephritis|Acute interstitial nephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Interstitial nephritis|Acute interstitial nephritis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 315: Line 298:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Analgesic]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Analgesic]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 338: Line 320:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nephrolithiasis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nephrolithiasis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 361: Line 342:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Reflux nephropathy|Reflux nephropathy (hydronephrosis)]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Reflux nephropathy|Reflux nephropathy (hydronephrosis)]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 385: Line 365:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal cell carcinoma|Renal cell carcinoma (RCC)]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal cell carcinoma|Renal cell carcinoma (RCC)]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 408: Line 387:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nephroblastoma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nephroblastoma]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 431: Line 409:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Transitional cell carcinoma|Transitional cell carcinoma (TCC)]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Transitional cell carcinoma|Transitional cell carcinoma (TCC)]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 454: Line 431:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostate cancer]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostate cancer]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 477: Line 453:
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Familial|Familial diseases]]
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Familial|Familial diseases]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Polycystic kidney disease]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Polycystic kidney disease]]
|
|Micro/Gross
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Palpable]] [[mass]] in the [[flank]]
* Palpable [[abdominal]] [[mass]] in the [[lumbar]] quadrant
* [[Palpable]] [[nodular]] [[hepatomegaly]]
| colspan="2" style="background: #F5F5F5; padding: 5px;" |
* [[Hypocitraturia]] in 65% on patients
* [[Hyperuricemia]] in 20% of patients
* [[Hyperoxaluria]] in 20% of patients
* Low [[urine pH]]
* [[Hematuria]] ([[microscopic]] or [[macroscopic]])
* [[Proteinuria]] usually less than 1 g/day
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Unilateral or bilateral [[cysts]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Hyperdense appearance,
* Septations
* Calcifications
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
[[Genetic]] testing demonstrates:
* Frame insertions/deletions
* Non-canonical [[splice]] site alterations
* Combined [[missense]] changes
| colspan="2" style="background: #F5F5F5; padding: 5px;" |
* Interstitial fibrosis
* Tubular atrophy
* Thickening and lamellation of tubular basement membranes
* Microcysts
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Negative immunofluorescence for complement and immunoglobulin
| style="background: #F5F5F5; padding: 5px;" |Ultrasound
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Medullary sponge kidney]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Medullary sponge kidney]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 525: Line 520:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arteriovenous malformation|Arteriovenous renal malformations]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arteriovenous malformation|Arteriovenous renal malformations]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 548: Line 542:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal vein thrombosis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal vein thrombosis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 571: Line 564:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Malignant hypertension]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Malignant hypertension]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 594: Line 586:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Polyarteritis nodosa]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Polyarteritis nodosa]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 617: Line 608:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Granulomatosis with polyangiitis|Wegner's granulomatosis polyangiitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Granulomatosis with polyangiitis|Wegner's granulomatosis polyangiitis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 640: Line 630:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Henoch-Schönlein purpura]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Henoch-Schönlein purpura]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 664: Line 653:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Benign prostatic hyperplasia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Benign prostatic hyperplasia]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 687: Line 675:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urolithiasis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urolithiasis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 710: Line 697:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Interstitial cystitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Interstitial cystitis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 733: Line 719:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Radiogenic|Radiogenic cystitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Radiogenic|Radiogenic cystitis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 757: Line 742:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemophilia|Coagulopathy (hemophilia)]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemophilia|Coagulopathy (hemophilia)]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 780: Line 764:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sickle cell anemia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sickle cell anemia]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 803: Line 786:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Abdominal aortic aneurysm]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Abdominal aortic aneurysm]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 826: Line 808:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphomas]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphomas]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 849: Line 830:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple myeloma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple myeloma]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 873: Line 853:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 896: Line 875:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cystitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cystitis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 919: Line 897:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 942: Line 919:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 965: Line 941:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 988: Line 963:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cytomegalovirus]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cytomegalovirus]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,011: Line 985:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Infectious mononucleosis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Infectious mononucleosis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,034: Line 1,007:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Condylomata acuminata]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Condylomata acuminata]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,058: Line 1,030:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Inserted [[bladder]] or [[Ureteral disease|ureteral catheters]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Inserted [[bladder]] or [[Ureteral disease|ureteral catheters]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,082: Line 1,053:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anticoagulants]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anticoagulants]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,107: Line 1,077:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Autoimmune hemolytic anemia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Autoimmune hemolytic anemia]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,130: Line 1,099:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Microangiopathic hemolytic anemia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Microangiopathic hemolytic anemia]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,153: Line 1,121:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thrombotic thrombocytopenic purpura]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thrombotic thrombocytopenic purpura]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,176: Line 1,143:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Paroxysmal nocturnal hemoglobinuria]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Paroxysmal nocturnal hemoglobinuria]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,199: Line 1,165:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Paroxysmal cold hemoglobinuria]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Paroxysmal cold hemoglobinuria]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,222: Line 1,187:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Malaria|Falciparum malaria]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Malaria|Falciparum malaria]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,245: Line 1,209:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prosthetic heart valve]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prosthetic heart valve]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,269: Line 1,232:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crush injury]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crush injury]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,292: Line 1,254:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Physical exercise|Vigorous muscle exercise]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Physical exercise|Vigorous muscle exercise]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,315: Line 1,276:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyperthermia|Hyperthermia (Heat stroke)]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hyperthermia|Hyperthermia (Heat stroke)]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,338: Line 1,298:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electric shock]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electric shock]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,361: Line 1,320:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Prolonged [[seizure]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Prolonged [[seizure]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,384: Line 1,342:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Polymyositis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Polymyositis]]
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|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,407: Line 1,364:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Trichinosis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Trichinosis]]
|
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,430: Line 1,386:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Haff disease]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Haff disease]]
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|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,453: Line 1,408:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bite injury|Animal venom bite]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bite injury|Animal venom bite]]
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 1,477: Line 1,431:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Phenazopyridine]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Phenazopyridine]]
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| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
Line 1,500: Line 1,453:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Beeturia|Beet (Beeturia)]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Beeturia|Beet (Beeturia)]]
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Revision as of 16:25, 20 July 2018

Hematuria Microchapters

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Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [1]

Overview

Gross hematuria(GH) must be distinguished from pigmenturia, which may be due to endogenous sources (e.g., bilirubin, myoglobin,and porphyrins), foods ingested (e.g., beets and rhubarb), drugs (e.g., phenazopyridine), and simple dehydration. This distinction can be made easily by urinalysis with microscopy. Notably, myoglobinuria and other factors can cause false-positive chemical tests for hemoglobin, so urine microscopy is required to confirm the diagnosis of hematuria. GH also must be distinguished from vaginal bleeding in women, which usually can be achieved by obtaining a careful menstrual history, collecting the specimen when the patient is not having menstrual or gynecologic bleeding, or, if necessary, obtaining a catheterized specimen. GH may also be detected by the presence of blood spotting on the undergarments of incontinent patients. After ruling out vaginal bleeding and mimics of hematuria, a urologic source must be suspected.

Differential Diagnosis

Hematuria should be differentiated from other disease which mimic hematuria especially hemoglobinuria and myoglobinuria which are dipstick positive but negative for microscopy.

Hematuria differential diagnosis

Differentiating the diseases that can cause hematuria:

Diseases Type of hematuria Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Low back pain Fever Nausea/Vomiting Urinary symptoms Hypertension Pitting edema Other Ultrasonography CT scan Other
Dysuria Frequency Oliguria Light microscopy Immunoflourescence pattern
Hematuria Glomerular diseases IgA nephropathy (Berger nephropathy) Microscopic + - - - + + + - -
Hereditary nephritis (Alport syndrome) Microscopic - - - - - - + -
  • Cataract
  • Hearing loss
 - - Renal Biopsy
  • Irregularly thin and attenuated GBM
  • Splitting of GBM
  • Scarring
Poststreptococcal glomerulonephritis Microscopic
Mesangioproliferative glomerulonephritis Microscopic
Focal segmental glomerular sclerosis Microscopic
Rapidly progressive glomerulonephritis Microscopic
Lupus nephritis Microscopic
Thin basement membrane disease Microscopic
Fabry disease Microscopic
Tubulointerstitial diseases Renal papillary necrosis Gross
Acute interstitial nephritis + + +
Analgesic
Nephrolithiasis
Reflux nephropathy (hydronephrosis)
Malignancy Renal cell carcinoma (RCC)
Nephroblastoma
Transitional cell carcinoma (TCC)
Prostate cancer
Familial diseases Polycystic kidney disease Micro/Gross + - - - - - + +
  • Unilateral or bilateral cysts
  • Hyperdense appearance,
  • Septations
  • Calcifications

Genetic testing demonstrates:

  • Frame insertions/deletions
  • Non-canonical splice site alterations
  • Combined missense changes
  • Interstitial fibrosis
  • Tubular atrophy
  • Thickening and lamellation of tubular basement membranes
  • Microcysts
  • Negative immunofluorescence for complement and immunoglobulin
 Ultrasound
Medullary sponge kidney
Vascular diseases Arteriovenous renal malformations
Renal vein thrombosis
Malignant hypertension
Polyarteritis nodosa
Wegner's granulomatosis polyangiitis
Henoch-Schönlein purpura
Lower urinary tract diseases Benign prostatic hyperplasia
Urolithiasis
Interstitial cystitis
Radiogenic cystitis
Systemic diseases Coagulopathy (hemophilia)
Sickle cell anemia
Abdominal aortic aneurysm
Lymphomas
Multiple myeloma
Infectious diseases Pyelonephritis
Cystitis
Prostatitis
Urethritis
Epididymitis
Cytomegalovirus
Infectious mononucleosis
Condylomata acuminata
Urogenital trauma Inserted bladder or ureteral catheters
Drugs Anticoagulants
Dark urine Hemoglobinuria Autoimmune hemolytic anemia
Microangiopathic hemolytic anemia
Thrombotic thrombocytopenic purpura
Paroxysmal nocturnal hemoglobinuria
Paroxysmal cold hemoglobinuria
Falciparum malaria
Prosthetic heart valve
Myoglobinuria Crush injury
Vigorous muscle exercise
Hyperthermia (Heat stroke)
Electric shock
Prolonged seizure
Polymyositis
Trichinosis
Haff disease
Animal venom bite
Chemicals Phenazopyridine
Beet (Beeturia)

References

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