Hematuria history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2] Steven C. Campbell, M.D., Ph.D. Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]

Overview

History and symptoms of hematuria depends on the etiology. The history should also include an assessment of associated symptoms, such as gross hematuria, voiding symptoms, or flank pain. Patients' risk factors for known causes of hematuria also should be queried. It is important to know the patient's urologic history, particularly any surgeries or febrile UTIs. It is also critical to ask about the patient's general medical history, to identify potentially contributory diagnoses, such as hypertension, renal insufficiency, bleeding disorders, or sickle cell disease. Current medication use, including anticoagulants and antiplatelet therapies, should be elicited, along with recent coagulation values and any concomitant medications that would potentiate the effects of blood thinners. Family history of nephritis, polycystic kidneys, and rare familial tumor syndromes of the kidney (e.g., von Hippel-Lindau) or urothelium (e.g., Lynch syndrome) also may be informative.

History and Symptoms

Medical history is crucial for the diagnostic evaluation of hematuria. Medical history can be detailed depending on the type of hematuria (microhematuria/gross).

• Microhematuria more commonly caused by glomerulopathys, urinary tract infection, benign prostate hypertrophy, and kidney stones, however, rulling out urinary tract cancer is crucial for evaluation.
  • Medical history should include the presence or absence of recent urinary tract infection, menstruation, sex, and urinary tract instrumentation to rule out these conditions while they might be the potential cause of hematuria.
• Medical history for the evaluation of gross (visible) hematuria should include the following:
  • Trauma
  • Urinary tract infection
  • Kidney stone
  • Surgical procedures and complications
  • Anticoagulant usage
  • Strenuous exercise (i.e., marathon running)
  • Voiding pattern (e.g., frequency, dribbling after urination, urgency, urinary retention, etc.)
  • Suprapubic pain
  • Flank pain

History and symptoms of hematuria according to its cause can be seen in the table below:

Cause of hematuria	History and symptoms
Ruptured abdominal aortic aneurysm	History of hypertension, peripheral vascular disease, or claudication Recent onset of severe, constant back, abdominal, or leg pain signs of vascular collapse and shock Tenderness in the costovertebral angle and flank
Clots with obstruction	History of hemodynamically significant bleeding Present with acute urinary retention present with inability to void.
Renal infarction	History of abdominal aortic or renal artery dissection, thromboembolic renal artery disease, atrial fibrillation or secondary to a procedure such as aortic or renal artery stenting. Present with accelerated hypertension, loin or flank or abdominal pain Fever, elevated leukocyte count and LDH levels and/or acute kidney failure
Trauma—renal or urogenital laceration or rupture	History of motor vehicle accident. Present with urgency to void and will generally be unable to do so.
Bleeding diathesis	Family history of personal history of bleeding or thrombosis, thrombocytopenia, coagulopathy Present with gingival bleeding and easy bruisability
Malignancy Bladder Prostate Ureter Kidney	Male gender, Age older than 35 years, Past or current smoking history, Occupational or other exposure to chemicals or dyes (benzenes or aromatic amines), Analgesic abuse, History of gross hematuria, History of urologic disorder or disease, History of Irritative voiding symptoms, History of pelvic irradiation, History of chronic urinary tract infection, Exposure to known carcinogenic agents or chemotherapy such as alkylating agents, History of chronic indwelling foreign body. Obstructive symptoms, pain, bloody discharge.
Nephrolithiasis	History of urinary tract stones. Present with severe abdominal, back, or flank pain
Glomerulonephritis	History of Upper respiratory tract infection, gastroenteritis, synchronous association of pharyngitis, children Hypertension, azotemia, dysmorphic erythrocytes, cellular casts, proteinuria. Symptoms of renal dysfunction such as malaise, fatigue, shortness of breath, and edema Signs may include hypertension and signs of volume overload such as distended jugular veins, lung crackles, S3 gallop, and leg edema
Urinary tract infection	History of UTI Present with fever and pertinent focal symptoms such as dysuria, urethral discharge.
Benign prostatic enlargement	Male with elderly age. Present with obstructive symptoms.
Polycystic kidney disease	Family history of renal cystic disease
Uretero-pelvic junction obstruction	History of UTI, stone, flank pain
Ureteral stricture	History of surgery or radiation, flank pain, hydronephrosis; stranguria, spraying urine
Urethral diverticulum	Discharge, dribbling, dyspareunia, history of UTI, female predominance
Fistula	Pneumaturia, Fecaluria, abdominal pain, recurrent UTI, history of diverticulitis or colon cancer
Exercise-induced hematuria	Recent vigorous exercise
Endometriosis	Cyclic hematuria in a menstruating woman
Papillary necrosis	African-American, sickle cell disease, diabetes, analgesic abuse
Interstitial cystitis	Voiding symptoms