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__NOTOC__
__NOTOC__
{{Hematuria}}
{{Hematuria}}
{{CMG}}; {{AE}} {{VSKP}}


{{CMG}}
==Overview==
Hematuria may be classified according to its source into 3 groups: extrarenal hematuria, nonglomerular renal hematuria, and glomerular hematuria. Hematuria may be classified according to the visibility of hematuria into 5 groups: Visible hematuria, initial hematuria, terminal hematuria, complete hematuria, and non-visible hematuria. Hematuria may be classified according to the duration into 2 groups: transient hematuria, and persistent or significant hematuria. Hematuria may also be classified according to the pathophysiology.


==Overview==
==Classification==
==Classification==
Red discoloration of the urine can have various causes:
Hematuria may be classified according to its source into 3 groups: extrarenal hematuria, nonglomerular renal hematuria, and glomerular hematuria.<ref name="pmid25382080">{{cite journal |vauthors=Bagnall P |title=Haematuria: classification, causes and investigations |journal=Br J Nurs |volume=23 |issue=20 |pages=1074–8 |date=2014 |pmid=25382080 |doi=10.12968/bjon.2014.23.20.1074 |url=}}</ref>
* [[Red blood cell]]s
*Extrarenal hematuria:: More than 60% of cases of hematuria occur from a source outside the kidney.The most common nonmalignant causes of hematuria outside the kidney are infections such as [[cystitis]] , [[prostatitis]] , and [[urethritis]] .
** [[Microscopic hematuria]] (small amounts of blood, can be seen only on [[urinalysis]] or [[light microscopy]])
*Nonglomerular renal hematuria: Renal stones and [[pyelonephritis]] will present with episodic pain and pyelonephritis with [[fever]]. [[Polycystic kidney disease|Polycystic kidney]] disease (PKD) will usually present with recurring gross hematuria. <ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref>Although the degree of [[proteinuria]] correlates with the severity and progression of renal disease, [[microscopic hematuria]] does not have such correlation.
** Macroscopic hematuria (or "frank" or "gross") hematuria
*Glomerular hematuria: [[IgA nephropathy]] is the most common cause of isolated glomerular microscopic hematuria (without significant proteinuria). It is usually asymptomatic and often is diagnosed as an incidental finding.
* [[Hemoglobin]] (only the red pigment, not the [[red blood cell]]s)
 
* Other pigments
Hematuria may be classified according to the visibility of hematuria into 5 groups: Visible hematuria, initial hematuria, terminal hematuria, complete hematuria, and non-visible hematuria.
** [[Porphyrin]]s in [[porphyria]]
*Visible hematuria: Also known as Frank hematuria/ Macroscopic hematuria/ Gross hematuria.<ref name="Pan2006">{{cite journal|last1=Pan|first1=Cynthia G.|title=Evaluation of Gross Hematuria|journal=Pediatric Clinics of North America|volume=53|issue=3|year=2006|pages=401–412|issn=00313955|doi=10.1016/j.pcl.2006.03.002}}</ref> Visible hematuria can be visualized and is also known as frank, gross or macroscopic hematuria.
** [[Betanin]], after eating [[beet]]s
*Initial hematuria: May indicate urethral pathology
*Terminal hematuria: Hematuria at the end of the stream that comes from the proximal [[urethra]] (bladder neck/prostate).
*Complete hematuria: Hematuria  throughout the entire stream suggests [[bladder]], ureteric or [[renal]] pathology.
*Non-visible hematuria: Non-visible hematuria encompasses dipstick and microscopic hematuria.<ref>{{cite web |url=http://www.surgeryjournal.co.uk/article/S0263-9319(10)00199-7/abstract |title=www.surgeryjournal.co.uk |format= |work= |accessdate=}}</ref>


Hematuria may be classified according to the duration into 2 groups: transient hematuria, and persistent or significant hematuria.
*Transient hematuria: A single urinalysis with hematuria is common and can result from [[menstruation]], [[Virus|viral]] illness, [[allergy]], exercise, fever, or mild [[trauma]].
*Persistent or Significant hematuria: >3 RBCs/HPF on three urinalyses, a single urinalysis with >100 RBCs, or gross hematuria.
Hematuria may be classified according to the pathophysiology.<ref name="pmid23896092">{{cite journal |vauthors=Lee JY, Chang JS, Koo KC, Lee SW, Choi YD, Cho KS |title=Hematuria grading scale: a new tool for gross hematuria |journal=Urology |volume=82 |issue=2 |pages=284–9 |date=August 2013 |pmid=23896092 |doi=10.1016/j.urology.2013.04.048 |url=}}</ref>
*Common causes of microscopic hematuria may be classified broadly according to the underlying etiology as [[glomerular]] and non glomerular, as follows:
{| class="wikitable"
|-
! colspan="2" style="width: 40%;" | Common Causes of Renal
! colspan="2" style="width: 60%;" | Common Causes of Non-Renal Hematuria
|-
!Glomerular hematuria
!Non-glomerular renal hematuria
!'''Upper urinary tract'''
!'''Lower urinary Tract'''
|-
| valign="top" |
* [[IgA nephropathy]] ([[Berger's disease]])
* [[Thin basement membrane disease|Thin glomerular basement membrane disease]]
* [[Hereditary nephritis]] ([[Alport syndrome|Alport's syndrome]])
* Infection related glomerulonephritis
* Pauci-immune glomerulonephritis
* Lupus nephritis
|
* Nephrocalcinosis
* Polycystic kidney disease
* Renal cell carcinoma
* Nutcracker syndrome
| valign="top" |
<br>
*[[Urolithiasis]]
*[[Pyelonephritis]]
*[[Transitional cell carcinoma]]
*[[Urinary obstruction]]
*[[Benign Recurrent Hamaturia|Benign hematuria]]
<br>
|<br>
*[[Cystitis|Bacterial cystitis]] ([[Urinary tract infection|UTI]])
*[[Benign prostatic hyperplasia]]
*[[Strenuous exercise]] ("marathon runner's hematuria")
*[[Transitional cell carcinoma]]
*Spurious hematuria (e.g. [[menses]])
*Instrumentation
*[[Benign Recurrent Hamaturia|Benign hematuria]] (e.g. [[interstitial cystitis]], [[trigonitis]])
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Nephrology]]
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[[Category:Urology]]
[[Category:Urology]]
[[Category:Emergency medicine]]
[[Category:Urologic Disease]]
[[Category:Urologic Disease]]
[[Category:Signs and symptoms]]
[[Category:Needs content]]
[[Category:Emergency medicine]]
{{WH}}
{{WS}}

Latest revision as of 15:40, 16 September 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Hematuria may be classified according to its source into 3 groups: extrarenal hematuria, nonglomerular renal hematuria, and glomerular hematuria. Hematuria may be classified according to the visibility of hematuria into 5 groups: Visible hematuria, initial hematuria, terminal hematuria, complete hematuria, and non-visible hematuria. Hematuria may be classified according to the duration into 2 groups: transient hematuria, and persistent or significant hematuria. Hematuria may also be classified according to the pathophysiology.

Classification

Hematuria may be classified according to its source into 3 groups: extrarenal hematuria, nonglomerular renal hematuria, and glomerular hematuria.[1]

  • Extrarenal hematuria:: More than 60% of cases of hematuria occur from a source outside the kidney.The most common nonmalignant causes of hematuria outside the kidney are infections such as cystitis , prostatitis , and urethritis .
  • Nonglomerular renal hematuria: Renal stones and pyelonephritis will present with episodic pain and pyelonephritis with fever. Polycystic kidney disease (PKD) will usually present with recurring gross hematuria. [2]Although the degree of proteinuria correlates with the severity and progression of renal disease, microscopic hematuria does not have such correlation.
  • Glomerular hematuria: IgA nephropathy is the most common cause of isolated glomerular microscopic hematuria (without significant proteinuria). It is usually asymptomatic and often is diagnosed as an incidental finding.

Hematuria may be classified according to the visibility of hematuria into 5 groups: Visible hematuria, initial hematuria, terminal hematuria, complete hematuria, and non-visible hematuria.

  • Visible hematuria: Also known as Frank hematuria/ Macroscopic hematuria/ Gross hematuria.[3] Visible hematuria can be visualized and is also known as frank, gross or macroscopic hematuria.
  • Initial hematuria: May indicate urethral pathology
  • Terminal hematuria: Hematuria at the end of the stream that comes from the proximal urethra (bladder neck/prostate).
  • Complete hematuria: Hematuria throughout the entire stream suggests bladder, ureteric or renal pathology.
  • Non-visible hematuria: Non-visible hematuria encompasses dipstick and microscopic hematuria.[4]

Hematuria may be classified according to the duration into 2 groups: transient hematuria, and persistent or significant hematuria.

  • Transient hematuria: A single urinalysis with hematuria is common and can result from menstruation, viral illness, allergy, exercise, fever, or mild trauma.
  • Persistent or Significant hematuria: >3 RBCs/HPF on three urinalyses, a single urinalysis with >100 RBCs, or gross hematuria.

Hematuria may be classified according to the pathophysiology.[5]

  • Common causes of microscopic hematuria may be classified broadly according to the underlying etiology as glomerular and non glomerular, as follows:
Common Causes of Renal Common Causes of Non-Renal Hematuria
Glomerular hematuria Non-glomerular renal hematuria Upper urinary tract Lower urinary Tract
  • Nephrocalcinosis
  • Polycystic kidney disease
  • Renal cell carcinoma
  • Nutcracker syndrome




References

  1. ↑ Bagnall P (2014). "Haematuria: classification, causes and investigations". Br J Nurs. 23 (20): 1074–8. doi:10.12968/bjon.2014.23.20.1074. PMID 25382080.
  2. ↑ Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 188 (6 Suppl):2473-81. DOI:10.1016/j.juro.2012.09.078 PMID: 23098784
  3. ↑ Pan, Cynthia G. (2006). "Evaluation of Gross Hematuria". Pediatric Clinics of North America. 53 (3): 401–412. doi:10.1016/j.pcl.2006.03.002. ISSN 0031-3955.
  4. ↑ "www.surgeryjournal.co.uk".
  5. ↑ Lee JY, Chang JS, Koo KC, Lee SW, Choi YD, Cho KS (August 2013). "Hematuria grading scale: a new tool for gross hematuria". Urology. 82 (2): 284–9. doi:10.1016/j.urology.2013.04.048. PMID 23896092.
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