Urology Book

http://www.fpnotebook.com/

Microscopic Hematuria Causes in AdultsAka: Adult Microscopic Hematuria Causes

Advertisement

  1. See Also
    1. Adult Hematuria
    2. Pediatric Hematuria
  2. Background
    1. Consider non-urine source (e.g. vagina or rectum)
  3. Most common causes of adult Hematuria by history
    1. Age
      1. Under age 40 years
        1. Genitourinary infection
        2. Nephrolithiasis
      2. Over age 40 years
        1. Urinary tract cancer (up to 10% of cases)
        2. Prostatic Disease
    2. Hematuria with pain
      1. Nephrolithiasis
      2. Renal Vein Thrombosis
      3. Renal Artery Occlusion
      4. Renal Cancer
    3. Hematuria with Dysuria
      1. Hemorrhagic cystitis (Urinary Tract Infection)
      2. Prostatic infection
      3. Bladder stones
    4. Hematuria with history of trauma
      1. Urethral disruption (seen in pubic Fracture)
      2. Bladder injury (seen in pelvic Fracture)
      3. Renal Laceration or rupture
  4. Causes of Asymptomatic Microscopic Hematuria by Incidence
    1. Benign essential Hematuria (37%)
    2. Benign Prostatic Hyperplasia (24%)
    3. Urethral Infection (21%)
    4. Urinary Tract Infection (7%)
    5. Nephrolithiasis (4%)
    6. Urethral calculus (2%)
    7. Bladder tumor (2%)
    8. Renal cyst (1.5%)
    9. Renal tumor (0.5%)
  5. Most important causes to rule-out (cancer and aneurysm)
    1. Bladder and Urethra Disease
      1. Bladder Cancer
      2. Urethral cancer
      3. Penile cancer
    2. Kidney and ureter disease
      1. Ureteral transitional cell cancer
      2. Renal cell cancer
      3. Renal transitional cell cancer
      4. Renal Lymphoma
    3. Prostate Disease
      1. Prostate Cancer
    4. Miscellaneous
      1. Metastatic cancer
      2. Abdominal Aortic Aneurysm
  6. Important causes to treat
    1. Bladder and Urethra Disease
      1. Urinary Tract Infection
        1. Acute Cystitis
        2. Pyelonephritis
        3. Mycobacterial cystitis
      2. Bladder calculus
      3. Urethral stricture or meatal stenosis
      4. Bladder papilloma
    2. Kidney and ureter disease
      1. Renal parenchymal disease
      2. Ureteropelvic junction obstruction
      3. Nephrolithiasis
      4. Vesicoureteral reflux
      5. Hydronephrosis
      6. Renal Artery Stenosis
      7. Renal vein thrombosis
    3. Prostate Disease
      1. Symptomatic Benign Prostatic Hyperplasia
      2. Prostatitis
  7. Important Causes to Observe
    1. Bladder and Urethra Disease
      1. Radiation cystitis
      2. Bladder diverticulum
      3. Bladder neck contracture
      4. Interstitial Cystitis
      5. Cystocele
      6. Neurogenic bladder
      7. Eosinophilic cystitis
      8. Phimosis
    2. Kidney and ureter disease
      1. Atrophic kidney
      2. Papillary necrosis
      3. Renal arteriovenous fistula
      4. Renal Contusion or trauma
      5. Polycystic kidney
      6. Ureterocele
      7. Glomerular Causes of Microscopic Hematuria
        1. IgA Nephropathy
          1. Associated with infectious illness
        2. Alport's Hereditary Nephritis
        3. Thin glomerular basement membrane disease (50%)
    3. Prostate Disease
      1. Asymptomatic Benign Prostatic Hyperplasia
  8. Benign Causes
    1. Bladder and Urethra Disease
      1. Inflammation of the urethral trigone
      2. Urethral polyp or Bladder neck polyp
      3. Bladder varices
      4. Trabeculated bladder
      5. Urethritis
    2. Kidney and ureter disease
      1. Pelvic kidney
      2. Renal cyst
      3. Duplicate collecting system
      4. Scarred kidney
      5. Calyceal diverticulum
    3. Prostate Disease
      1. Prostatic stone
    4. Miscellaneous
      1. Exercise Hematuria
  9. Systemic Causes
    1. Cardiovascular and hematologic causes
      1. Endocarditis
    2. Rheumatologic Causes
      1. Systemic Lupus Erythematosus
      2. Vasculitis
    3. Medications
      1. See Medication Causes of Hematuria
      2. Interstitial Nephritis (Gold, Penicillamine, NSAIDs)
      3. Warfarin (if associated with urologic anomaly)
    4. Infections
      1. Acute Post-Streptococcal Glomerulonephritis
      2. Henoch-Schonlein Purpura
      3. Tuberculosis
  10. References
    1. Grossfield (1998) Urol Clin North Am 25:661

Navigation Tree