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aetiology by site


  • coagulopathy
  • sickle haemoglobinopathies

glomerular (esp. if glomerular RBCs &/or red cell casts)

  • primary glomerular disease
  • multisystem disease:
    • SLE, HSP, HUS, PAN, Wegener's granulomatosis, Goodpasture's syndrome

non-glomerular renal

  • white cell casts (but these may be absent?):
  • medullary sponge kidney
  • renal infarction
  • tumour
  • vascular malformation
  • trauma


  • stones
  • trauma
  • tumour of ureter, bladder, urethra
  • cystitis
  • TB
  • prostatitis, urethritis
  • urinary catheter
  • exercise
  • benign prostatic hypertrophy

most common causes by age:

< 20 yrs:

  • GN, UTI, trauma


  • UTI, stone, trauma, Ca bladder/kidney

40-60yrs males:

  • Ca bladder, stone, UTI, Ca kidney, BPH if > 60yrs

40-60yrs females:

  • UTI, stone, Ca bladder/kidney

general approach

haematuria characteristics

  • blood noted only on initiation suggests urethral cause
  • blood seen mainly on last few drops suggests prostatic or bladder neck source (including blood clots pooling at base of bladder)
    • may occur after injury or straining
  • haematuria throughout urination suggests source in bladder, ureter or kidney
  • brown or smoky-colored urine usually has a renal source
  • blood clots indicate non-glomerular renal or lower urinary tract source
  • if cyclic with menses, may be due to endometriosis of ureter or bladder

associated symptoms/historical features:

  • flank pain suggests calculus, neoplasm, renal infarction, obstruction or infection as a cause
  • symptoms of dysuria, frequency or suprapubic pain suggests cystitis or urethritis
  • in adult men, perineal pain, dysuria and terminal haematuria suggests prostatitis
  • recent sore throat suggests possibility of post-streptococcal GN
  • foreign travel or residence suggests schistosomiasis or TB
  • drugs may cause acute interstitial nephritis, papillary necrosis, or haemorrhagic cystitis
  • FH of HbS, polycystic or other kidney disease or renal calculi
  • 15-20% of individuals exhibit haematuria after strenuous exercise which resolves in a few days

examination findings:

  • arthritis, skin lesions, HT or oedema suggest GN
  • new heart murmur (endocarditis) or AF suggests renal embolism
  • costovertebral angle tenderness suggests pyelonephritis, stone disease
  • enlarged kidney suggests polycystic kidney or malignancy
  • prostatic examination may offer clues to presence of prostatitis, BPH or malignancy
  • ext. genitalia may reveal urethral meatal lesion
  • PV exam to exclude vulvovaginal causes of bleeding
  • urinalysis with m/c/s if ? infective
  • if suspect calculi, polycystic kidney, tumour or obstruction then IVP or if C/I then US
  • if active gross haematuria or no upper lesion then consider cystoscopy
  • if elderly pt and other features are unhelpful then consider urinary cytology
  • if asymptomatic, with no other abnormality on urinalysis, and not azotaemic, hypertensive, or severely anaemic, & who have no evidence of intrinsic renal disease, may be followed up as outpatients (?except if known bleeding disorder), others should generally be admitted for prompt evaluation.
  • extensive OP evaluation is usually not undertaken for pts < 40 yrs with isolated episode of haematuria, but most patients over 40yrs should have a thorough evaluation

Mx of blood clots causing urinary blockage and urinary retention

haematuria.txt · Last modified: 2022/07/02 01:09 by wh

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