Hematuria

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Pattern Recognition

Clues from the history that point toward a specific diagnosis include:

1. Concurrent pyuria and dysuria are usually indicative of a urinary tract infection.

2. A recent upper respiratory infection suggests either postinfectious glomerulonephritis or IgA nephropathy

3. A positive family history of renal failure, suggests hereditary nephritis or polycystic kidney disease.

4. Unilateral flank pain, which may radiate to the groin, suggests ureteral obstruction due to a calculus or blood clot.

5. Symptoms of prostatic obstruction in older men such as hesitancy and dribbling may indicate prostatic disease.

6. Recent vigorous exercise or trauma are clues to exercise induced hematuria.

7. History of a bleeding disorder or bleeding from multiple sites due to uncontrolled anticoagulant therapy. It should not be assumed that hematuria alone can be explained by chronic warfarin therapy. Hematuria in an anticoagulated patient should generally be evaluated in the same fashion as in other patients unless there is evidence of bleeding from multiple sites with markedly abnormal coagulation studies.

8. Cyclic hematuria in women that is most prominent during and shortly after menstruation, suggests endometriosis of the urinary tract. Contamination with menstrual blood is also a possibility, and should be ruled out by repeating the urinalysis when menstruation has ceased.

9. Medications that might cause nephritis (usually with other findings, typically with renal insufficiency).

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