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| __NOTOC__ | | __NOTOC__ |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| {{Infobox_Disease |
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| Name = {{PAGENAME}} |
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| Image = |
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| Caption = |
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| DiseasesDB = 19635 |
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| ICD10 = {{ICD10|N|02||n|00}}, {{ICD10|R|31||r|30}} |
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| ICD9 = {{ICD9|599.7}}, {{ICD9|791.2}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| MeshID = D006417 |
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| }}
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| {{Hematuria}} | | {{Hematuria}} |
| {{SCC}} | | '''For patient information, click [[{{PAGENAME}} (patient information)|here]]''' |
| {{SK}} Haematuria
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| ==Overview==
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| '''Hematuria''' is the presence of [[red blood cells]] (erythrocytes) in the [[urine]]. Occasionally the term "[[hemoglobinuria]]" is used synonymously, although more precisely it refers only to [[hemoglobin]] in the urine.
| | {{CMG}}; {{AE}} {{Adnan Ezici}} {{SCC}} {{VSKP}} {{AIDA}} |
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| == Types of Hematuria==
| | {{SK}} Haematuria; urinary tract bleeding; blood in urine<br><br>'''To view a comprehensive algorithm of common findings of urine composition and urine output, click [[Urine#Algorithm of Common Urinary Findings|here]]'''<br> |
| Red discoloration of the urine can have various causes:
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| * [[Red blood cell]]s
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| ** [[Microscopic hematuria]] (small amounts of blood, can be seen only on [[urinalysis]] or [[light microscopy]])
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| ** Macroscopic hematuria (or "frank" or "gross") hematuria
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| * [[Hemoglobin]] (only the red pigment, not the [[red blood cell]]s)
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| * Other pigments
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| ** [[Porphyrin]]s in [[porphyria]]
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| ** [[Betanin]], after eating [[beet]]s
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| ==Symptoms== | | ==[[Hematuria overview|Overview]]== |
| In assessing the underlying cause of hematuria, the patient should be asked the following questions::
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| * Have you passed any [[blood clot]]s?
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| * Has a [[kidney stone]] been passed (have you heard a noise in toilet bowl)?
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| * Is the red color mixed in completely, or does the color change during an episode of urination?
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| * Does it occur only after getting up?
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| * Have you recently had a sore throat?
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| == Diagnosis == | | ==[[Hematuria definition|Definition]]== |
| Often, the diagnosis is made on the basis of the medical history and some [[blood test]]s—especially in young people in whom the risk of malignancy is negligible and the symptoms are generally self-limited.
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| [[Ultrasound]] investigation of the renal tract is often used to distinguish between various sources of bleeding. [[X-ray]]s can be used to identify [[kidney stone]]s, although [[computed axial tomography|CT scanning]] is more precise. | | ==[[Hematuria historical perspective|Historical Perspective]]== |
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| In older patients, [[cystoscopy]] with [[biopsy]] of suspected lesions is often employed to investigate for [[bladder cancer]].
| | ==[[Hematuria classification|Classification]]== |
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| * [[Urinalysis]] for all patients
| | ==[[Hematuria pathophysiology|Pathophysiology]]== |
| * [[Complete blood count]] ([[CBC]])
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| * [[Calcium]]
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| * [[Uric acid]]
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| * [[Prothrombin time]] / [[Partial thromboplastin time]] ([[PT]] / [[PTT]])
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| * [[Blood urea nitrogen]] ([[BUN]]) / [[creatinine]]
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| A more complete evaluation would include the following:
| | ==[[Hematuria causes|Causes]]== |
| * C3 levels
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| * Red blood cells casts
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| * Cyroglobulins
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| * Hepatitis C antibodies
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| * Anti-glomerular basement membranes (GBM)
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| * Antinuclear anitbodies (ANA)
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| * Antineutrophil cytoplasmic antibodies (ANCA)
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| * Antistreptolysin O antibodies (ASO)
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| == Common Causes == | | ==[[Hematuria differential diagnosis|Differentiating Hematuria from other Diseases]]== |
| Common causes of ''macroscopic hematuria/ haematuria'' (i.e. blood visible in the urine) include:
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| * [[Thin basement membrane disease|Benign familial hematuria]]
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| * Urinary [[Schistosomiasis]] (caused by ''[[Schistosoma haematobium]]'') - a major cause for hematuria in many African and Middle-Eastern countries;
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| * [[IgA nephropathy]] ("Berger's disease") - occurs during viral infections in predisposed patients;
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| * [[Kidney stone]]s (or [[bladder stone]]s, now a rare disease);
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| * [[Bladder cancer]];
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| * [[Renal cell carcinoma]] - occasionally presents with bleeding;
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| * [[Paroxysmal nocturnal hemoglobinuria]] - a [[rare disease]] where [[hemoglobin]] of [[hemolysis|hemolysed]] cells is passed into the urine.
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| * [[Urinary tract infection]] with some bacterial species including strains of [[Escherichia coli#Urinary tract infections|EPEC]] and [[Staphylococcus saprophyticus]]
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| * [[Sickle cell trait]] can precipitate large amounts of red blood cell discharge, but only a small number of individuals endure this problem
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| * [[Arteriovenous malformation]] of the kidney (rare, but may impress like renal cell carcinoma on scans as both are highly vascular)
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| * Nephritic syndrome ( a condition associated with post-streptococcal and rapidly progressing glomerulonephritis.
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| * Ureteral Pelvic Junction Obstruction (UPJ) is a rare condition beginning from birth in which the ureter is blocked between the kidney and bladder. This condition may cause blood in the urine.<ref>http://www.emoryhealthcare.org/departments/urology/sub_menu/upj.html</ref>
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| == Differential Diagnosis == | | ==[[Hematuria epidemiology and demographics|Epidemiology and Demographics]]== |
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| | ==[[Hematuria risk factors|Risk Factors]]== |
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| === Main Causes === | | ==[[Hematuria screening|Screening]]== |
| * [[Bladder carcinoma]]
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| * Contamination during menstruation
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| * [[Cystitis]]
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| * [[Glomerulonephritis]]
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| * [[Prostatic hypertrophy]]
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| * [[Pyelonephritis]]
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| * [[Prostatitis]]
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| * [[Renal carcinoma]]
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| * [[renal stones|Stones]]
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| * [[Urinary Tract Infection]] ([[UTI]])
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| === Other Causes === | | ==[[Hematuria natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * Acute/chronic [[Cystitis]]
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| * Acute intestinal [[nephritis]]
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| * [[Adenovirus]]
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| * After [[Endocarditis]]
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| * Allergic [[Granulomatosis]]
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| * [[Alport's Syndrome]]
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| * Analgesic kidney
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| * [[Arteriosclerosis]]
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| * [[Balkan Nephropathy]]
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| * [[Beeturia]]
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| * [[Benign familial hematuria]]
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| * [[Berger's Disease]]
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| * [[Bilharziosis]]
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| * Bladder infiltration
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| * Bladder [[tuberculosis]]
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| * [[Calyx Diverticulum]]
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| * [[Chemotherapeutics]]
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| * Consumption coagulopathy
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| * [[Crescentic glomerulonephritis]]
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| * Cystic kidneys
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| * [[Cytomegalovirus]] ([[CMV]])
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| * [[Dermatosclerosis]]
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| * [[Diabetes Mellitus]]
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| * Diabetic glomerulosclerosis/[[diabetic nephropathy]]
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| * [[Drug]]s
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| * [[ECHO viruses]] ('''E'''nteric '''C'''ytopathic '''H'''uman '''O'''rphan)
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| * [[E.coli]]
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| * [[Endometriosis]]
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| * [[Fabry's Disease]]
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| * Factor lack
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| * [[Filaria]]
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| * [[Fistula]]
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| * Focal glomerulotnephritis
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| * Foods
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| * Foreign body in urethra
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| * [[Goodpasture's Syndrome]]
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| * [[Heart failure]]
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| * Heavy exercise
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| * [[Hemoglobinopathy]]
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| * [[Hemophilia]]
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| * [[Hemolytic Uremic Syndrome]]
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| * [[Hemorrhage]] from bladder outlet
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| * [[Hemorrhage]] from urethra
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| * [[Hepatitis B]]
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| * [[Hydronephrosis]]
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| * [[Hypernephroma]]
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| * [[Hypertension]]
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| * [[Inflammation]]
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| * [[Influenza]]
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| * [[Injury]]
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| * Kidney [[Amyloidosis]]
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| * Kidney cell [[carcinoma]]
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| * Kidney [[tuberculosis]]
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| * [[Legionella]] Infection
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| * [[Systemic Lupus Erythematosus]]
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| * Malignant [[Hypertension]]
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| * [[Masturbation]]
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| * [[Meatus Stenosis]]
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| * [[Megaureter]]
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| * [[Membranoproliferative glomerulonephritis]]
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| * [[Metastases]]
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| * [[Mononucleosis]]
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| * [[Multiple Myeloma]]
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| * [[Mycoplasma]]
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| * [[Myoglobinuria]]
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| * [[Nail-Patella Syndrome]]
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| * [[Neoplasm]]
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| * [[Nephrocalcinosis]]
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| * [[Nephrolithiasis]]
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| * [[Osler's Disease]]
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| * [[Polyarteritis Nodosa]]
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| * [[Polycystic Kidney Disease]]
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| * [[Polycythemia Vera]]
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| * [[Porphyria]]
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| * [[Postinfectious glomerulonephritis]]
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| * [[Plasmodium]]
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| * Prostate [[adenoma]]
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| * [[Prostate carcinoma]]
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| * Prostate [[hyperplasia]]
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| * Prostate [[tuberculosis]]
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| * [[Pseudomonas]]
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| * [[Pyelonephritis]]
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| * Radiation nephropathy
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| * Renal artery aneurysm
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| * [[Renal cyst]]
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| * Renal [[hyperplasia]]
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| * Renal infarct
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| * Renal pelvis carcinoma
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| * [[Renal Stones]]
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| * Renal trauma
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| * Renal vein infarct
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| * [[Renal Vein Thrombosis]]
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| * [[Salmonella]]
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| * [[Sarcoidosis]]
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| * [[Schistosoma]]
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| * Schonlein-Henoch's Disease
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| * [[Shock]]
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| * Shunt nephritis
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| * [[Sickle Cell Anemia]]
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| * Sponge kidney
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| * [[Staphylococci]]
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| * [[Streptococci]]
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| * [[Thalassemia]]
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| * [[Thin Basement Membrane Disease]]
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| * Thrombocytopathies
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| * [[Thrombocytopenia]]
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| * [[Thrombotic Thrombocytopenic Purpura]]
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| * [[Toxin]]s
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| * [[Toxoplasma]]
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| * [[Trauma]]
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| * Traumatic kidney lesion
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| * [[Trichinella Spiralis]]
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| * [[Tubulointerstitial nephropathies]], [[nephritis]]
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| * [[Tumor]]
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| * [[Urate]] [[nephropathy]]
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| * [[Ureter]] [[carcinoma]]
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| * [[Ureter]] [[tuberculosis]]
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| * [[Urethra]] [[carcinoma]]
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| * [[Urethral]] [[carbuncle]]
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| * [[Urethral]] valves
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| * [[Urethritis]]
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| * Urethrolithiasis
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| * Urogential tuberculosis
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| * [[Urolithiasis]]
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| * [[Urothelium]] [[carcinoma]]
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| * [[Varicella]]
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| * Vesical calculi
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| * Vesico-ureteral-renal reflux
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| * [[Warfarin]] therapy (overdose)
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| * [[Wegener's Granulomatosis]]
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| * [[Wilms' Tumor]]
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| ==References== | | ==Diagnosis== |
| {{reflist|2}}
| | [[Hematuria diagnostic evaluation| Diagnostic Evaluation]] | [[Hematuria history and symptoms| History and Symptoms]] | [[Hematuria physical examination | Physical Examination]] | [[Hematuria laboratory findings|Laboratory Findings]] | [[Hematuria electrocardiogram|Electrocardiogram]] | [[Hematuria x ray|X-ray]] | [[Hematuria echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Hematuria CT|CT]] | [[Hematuria other imaging findings|Other Imaging Findings]] | [[Hematuria other diagnostic studies|Other Diagnostic Studies]] |
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| [[ar:بول دموي]]
| | ==Treatment== |
| [[de:Hämaturie]] | | [[Hematuria medical therapy|Medical Therapy]] | [[Hematuria interventions|Interventions]] | [[Hematuria surgery|Surgery]] | [[Hematuria primary prevention|Primary Prevention]] | [[Hematuria secondary prevention|Secondary prevention]] | [[Hematuria cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hematuria future or investigational therapies|Future or Investigational Therapies]] |
| [[es:Hematuria]] | |
| [[fr:Hématurie]] | |
| [[it:Ematuria]] | |
| [[he:המטוריה]] | |
| [[ja:血尿]] | |
| [[pt:Hematúria]] | |
| [[qu:Yawar ispay]]
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| [[ru:Гематурия]]
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| [[fi:Verivirtsaisuus]]
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| [[zh:血尿]]
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| = Epidemiology and Demographics =
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| * 2.5% of the general population has asymptomatic hematuria
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| === Other Diagnostic Studies ===
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| * Three-tube test
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| * Centrifuge urine sample
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| * Urine cytology
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| * Urine cytoscopy
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| * Renal biopsy
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| = Treatment =
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| * Older patients with transient hematuria should be evaluated for urinary tract cancers
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| * Urologic consult if necessary
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| * Treat underlying etiologies
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| * Increase hydration (stones)
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| == Pharmacotherapy ==
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| === Acute Pharmacotherapies ===
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| * Antibiotics (UTI)
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| * Analgesics (stones)
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| == Surgery and Device Based Therapy ==
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| * Biopsy for patients for glomerular sources
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| == Acknowledgements ==
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| The content on this page was first contributed by {{CMG}}
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| <br>
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| | ==Case Studies== |
| | [[Hematuria case study one|Case #1]] |
| | [[pl:Hematuria]] |
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| | {{WH}} |
| | {{WS}} |
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| [[Category:Nephrology]] | | [[Category:Nephrology]] |
| [[Category:Urology]] | | [[Category:Urology]] |
| | [[Category:Emergency medicine]] |
| [[Category:Urologic Disease]] | | [[Category:Urologic Disease]] |
| [[Category:Signs and symptoms]]
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| [[Category:Emergency medicine]]
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| [[pl:Hematuria]]
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