Hematuria overview

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Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [1]

Overview

Hematuria is the presence of blood in the urine and is a common condition in urological practice. It accounts for around 20% of urological referrals and is important, as it can be a cardinal symptom of urological malignancy. Around 40% of patients investigated for hematuria are found to have significant underling pathology, half of whom will have a urological malignancy. Therefore, all patients presenting with a single episode of haematuria require urgent investigation. Haematuria in adults should be regarded as a symptom of urological malignancy until proven otherwise. Microscopic hematuria, or microhematuria (MH), is defined as the presence of red blood cells (RBCs) on microscopic examination of the urine not evident on visual inspection of the urine. The prevalence of MH among healthy participants in screening studies is 6.5% (95% confidence interval [CI] 3.4 to 12.2), with higher rates in studies with a predominance of males, older patients, and smokers.

Definition

Definitions for MH vary considerably and range between 1 to 10 red blood cells per high-power fiel. This difference is due to factors affecting related to sample collection and quantification. One of the the most widely used definition of MH is the presence of three or greater red blood cells per high power-field on a properly collected urinary specimen in the absence of an obvious benign cause (e.g. mild trauma or sexual activity preceding the collection).

Classification

Hematuria may be classified based on its source, visibility, duration and pathophysiology.

classification by its source	Classification by the visibility	Classification by the duration of hematuria	Classification by Pathophysiology
Extrarenal hematuria Nonglomerular renal hematuria Glomerular hematuria	Visible hematuria Non-Visible hematuria	Transient hematuria Persistent or Significant hematuria	Glomerular hematuria Non-glomerular renal hematuria Upper urinary tract Lower urinary Tract