- Proteinuria is present in most cases of glomerular hematuria but
not in cases of non glomerular hematuria. - Casts such as proteinuria.
- Blood clots indicate non-glomerular bleeding and can be
associated with pain & colic.
Differential Diagnosis of Hematuria:
A. First, hematuria should be differentiated from other causes of red or
brownish urine:
- Microscopy will show RBC's only with hematuria.
- Dipsticks (Hemastix) will be positive with hemoglobinuria
(hemolysis) and myoglobinuria (muscle damage) but negative with
other causes e.g. porphyrins (in porphyria), bile (in jaundice),
melanin (in melanoma), alkaptonuria, food dyes and drugs as PAS
or phenylphthalein.
B. Hematuria may be of renal, ureteral, bladder or urethral origin.
I. Haematuria of renal origin:
a. Glomerular haematuria: Either primary glomerular disease (e.g. IgA
nephropathy, mesangial proliferative glomerulonephritis or crescentic
glomerulonephritis); or secondary glomerulonephritis i.e. renal
involvement is a part of systemic disease (e.g. post-streptococcal
glomerulonephritis, Henoch-Schönlein purpura, SLE, polyarteritis
nodosa).
b. Renal infection: Pyelonephritis (especially with papillary necrosis) or
renal tuberculosis.
c. Renal neoplastic disease: Renal cell carcinoma, transitional cell
carcinoma of the renal pelvis and others.
d. Hereditary renal disease: Medullary sponge kidney or polycystic
kidney disease.