Hematuria differential diagnosis: Difference between revisions

Jump to navigation Jump to search
Line 819: Line 819:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis]]
|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;" |+
| 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;" |
* [[Delirium]]
* [[Delirium]]
Line 840: Line 840:
* [[Abscess|Abscesses]] may not be present
* [[Abscess|Abscesses]] may not be present
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Contrast nephrograms
Contrast nephrograms
* Focal areas of striated or wedge-shaped [[hypoperfusion]]
* Focal areas of striated or wedge-shaped [[hypoperfusion]]
Line 847: Line 846:
*Interstitial fibrosis
*Interstitial fibrosis
*[[Renal casts]]
*[[Renal 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;" |
| style="background: #F5F5F5; padding: 5px;" |

Revision as of 17:16, 20 July 2018

Hematuria Microchapters

Home

Patient Information

Overview

Definition

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hematuria from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hematuria differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hematuria differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hematuria differential diagnosis

CDC on Hematuria differential diagnosis

Hematuria differential diagnosis in the news

Blogs on Hematuria differential diagnosis

Directions to Hospitals Treating Hematuria

Risk calculators and risk factors for Hematuria differential diagnosis

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
Vascular diseases Renal vein thrombosis Micro/Gross + + + - - - - -
  • Asymptomatic
  • Abdominal pain
  • Acute in onset
  • Elevation in serum lactate dehydrogenase
  • Cholesterol levels for hypercholesterolemia
  • Albumin levels for hypoalbuminemia
  • Serum complement levels
  • Diagnostic screening
  • Renal venography: Gold standard
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 Gross + + + + + + - -
  • Enlarged kidneys

Contrast nephrograms

-
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

Template:WH Template:WS