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Hematuria

Last updated: January 21, 2021

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Hematuria, defined as the presence of red blood cells (RBCs) in the urine, can be classified according to quantity, occurrence during voiding, and origin of bleeding. In microhematuria, color changes in the urine are not clearly visible to the naked eye, and RBCs are only detectable under microscopy. Macrohematuria (gross hematuria) is visible discoloration of urine that results from frank blood. Glomerular hematuria originates from damage to the glomeruli. Nonglomerular hematuria results from damage to the kidneys or upper/lower urinary tract. If hematuria is detected, patients should undergo further evaluation (e.g., urinalysis) to determine the underlying cause. Other causes of red discoloration of the urine include myoglobinuria, porphyria, certain drugs (e.g., rifampin), and the consumption of certain foods (e.g., beetroots).

According to quantity

According to the occurrence during voiding

Gross painless hematuria is the most common clinical finding in urinary tract cancer and should be evaluated with cystoscopy.

According to origin

Glomerular hematuria

Nonglomerular hematuria

Medical history and physical examination

Urinalysis

When hematuria (red or brown urine, positive urine dipstick) is suspected, the presence of RBCs must be confirmed with microscopic analysis of the urine sediment.

Findings of glomerular and nonglomerular hematuria

Glomerular vs. nonglomerular hematuria [3]
Glomerular hematuria Nonglomerular hematuria
Color (macroscopic)
  • Often normal
  • Sometimes light red
RBC morphology
  • Normal (isomorphic)
RBC casts
  • Sometimes present
  • Absent
Clots
  • Absent
  • Sometimes present
Proteinuria
  • < 500 mg/day

Diagnosis of underlying disease

The differential diagnoses listed here are not exhaustive.

  1. Mount DB, Pollak MR. Molecular and Genetic Basis of Renal Disease. Elsevier Health Sciences ; 2008
  2. Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults.. Am Fam Physician. 2013; 88 (11): p.747-54.
  3. Estrada CR. Traumatic Hematuria. In: Myers JA, Millikan KW, Saclarides TJ, eds. Common Surgical Diseases. Springer ; 2008.