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

Classification by the extent of hematuria

1. Dipstick hematuria: Detection of hemoglobin within red blood cells using reagent strips in macroscopically normal urine.This describes the use of reagent strips to detect blood chemically within urine.
2. Microscopic hematuria: Defined as the presence of more than two to five red blood cells per high powered field within macroscopically normal urine on a properly collected urinary specimen in the absence of an obvious benign cause.
3. Macroscopic hematuria: Defined as the presence of blood in urine that is visible with naked eye.

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.