Hematuria classification

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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 based on its source, visibility, duration and pathophysiology.

Classification

Hematuria may be classified by its source

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 .
2. 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. Although the degree of proteinuria correlates with the severity and progression of renal disease, microscopic hematuria does not have such correlation.
3. 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.

Classification by the visibility of hematuria

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

Classification by the duration of hematuria

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

Classification by Pathophysiology

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
IgA nephropathy (Berger's disease) Thin glomerular basement membrane disease Hereditary nephritis (Alport's syndrome) Infection related glomerulonephritis Pauci-immune glomerulonephritis Lupus nephritis	Nephrocalcinosis Polycystic kidney disease Renal cell carcinoma Nutcracker syndrome	Urolithiasis Pyelonephritis Transitional cell carcinoma Urinary obstruction Benign hematuria	Bacterial cystitis (UTI) Benign prostatic hyperplasia Strenuous exercise ("marathon runner's hematuria") Transitional cell carcinoma Spurious hematuria (e.g. menses) Instrumentation Benign hematuria (e.g. interstitial cystitis, trigonitis)