Hematuria history and symptoms

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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

History and symptoms of hematuria depends on the eitology. 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.[1]

History

Cause of hematuria[1]
History, symptoms and signs
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

Causes 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, 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
Hematologic or thrombotic disease
Family history of personal history of bleeding or thrombosis
Papillary necrosis
African-American, sickle cell disease, diabetes, analgesic abuse
Interstitial cystitis
Voiding symptoms

Symptoms

  • Passing blood clots or urine appear red in color.
  • Passing stones in urine.
  • Occurring in the early morning void or whole day.
  • Recent infection or a recent sore throat.

References

  1. 1.0 1.1 Wein, Alan (2016). Campbell-Walsh urology. Philadelphia, PA: Elsevier. ISBN 978-1455775675.

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