Ver el código de «Hematuria»

==Background==
[[File:Macroscopic hematuria.png|thumb|Macroscopic Hematuria algorithm]]
*Make sure hematuria is not myoglobin or bleeding from non-urinary source
*Hematuria + pain suggests UTI or nephrolithiasis
*Hematuria + no pain suggests malignancy, hyperplasia, or vascular cause

===Common Causes===
*Pediatric patients
**[[Glomerulonephritis]]
**[[UTI]]
**Congenital urinary tract anomaly
*Younger adults
**[[UTI]]
**[[Nephrolithiasis]]
*Older adults
**[[UTI]]
**Neoplasm
**[[BPH]]
*Any age
**[[Schistosomiasis]] (most common cause worldwide)

==Clinical Features==
===Types of hematuria===
*Initial hematuria
**Blood at beginning of micturition with subsequent clearing
**Suggests urethral disease
*Intervoid hematuria
**Blood between voiding only (voided urine is clear)
**Suggests lesions at distal urethra or meatus
*Total hematuria
**Blood visible throughout micturition
**Suggests disease of kidneys, ureters, or bladder
*Terminal hematuria
**Blood seen at end of micturition after initial voiding of clear urine
**Suggests disease at bladder neck or prostatic urethra
*Gross hematuria
**Indicates lower tract cause
*Microscopic hematuria
**Tends to occur with kidney disease
*Brown urine with RBC casts and proteinuria
**Suggests glomerular source
*Clotted blood
**Indicates source below kidneys

==Workup==
*Labs:
**[[Urinalysis]]
****Microscopic hematuria associated with proteinuria requires further investigation (as an outpatient)
***Suggests glomerular disease
*Consider CT imaging to assess for renal tumors, stones, or aneurysm
*Ultrasound useful to assess for [[Renal ultrasound|hydronephrosis]] or a [[Aortic ultrasound|Abdominal Aortic Aneurysm]]

===Blunt Trauma<ref>Mee S. et al. Radiographic assessment of renal trauma: A 10-year prospective study of patient selection. J Urology. 1989 May;141(5):1095-8</ref>===
Renal injuries are associated with:
*Sudden deceleration injury without hematuria
*Gross Hematuria
*Microscopic Hematuria with Shock (SBP<90 mm Hg)

*The degree of hematuria does not correlate with significance of renal injury

==Differential Diagnosis==
{{Hematuria DDX}}

{{Pediatric hematuria DDX}}

==Management==
*Treat underlying cause
*Gross hematuria
**Often associated with intravesicular clot formation and bladder outlet obstruction
***Use triple-lumen urinary drainage catheter with intermittent or continuous bladder irrigation
****Adequate urinary drainage must be ensured; otherwise consult urology

==Disposition==
*Outpatient management appropriate if:
**Hemodynamically stable without life-threatening cause of hematuria
**Able to tolerate oral fluids, antibiotics, and analgesics as indicated
**No significant anemia or acute renal insufficiency
*Patients <40 yr: refer to primary care provider for repeat UA within 2wk
*Patients >40 yr with risk factor for urologic cancer: refer to urologist within 2wk
**Risk factors:
***Smoking history
***Occupational exposure to chemicals or dyes
***History of gross hematuria
***Previous urologic history
***History of recurrent UTI
***Analgesic abuse
***History of pelvic irradiation
***[[Cyclophosphamide]] use
***Pregnancy
***Known malignancy
***Sickle cell disease
***[[Proteinuria]]
***Renal insufficiency
*Admit:
**Intractable pain
**Intolerance of oral fluids and medications
**Bladder outlet obstruction
**Suspected or newly diagnosed [[glomerulonephritis]]
***High risk of developing complications ([[pulmonary edema]], volume overload, [[hypertensive emergency]])
**Pregnant women (hematuria can accompany [[preeclampsia]], [[pyelonephritis]] or obstructing [[nephrolithiasis]])

==See Also==
[[Hematuria (Peds) DDx]]

==References==
<references/>

[[Category:Renal]]