Hematuria Differential Diagnoses

  • Author: Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD   more...
 
Updated: Apr 20, 2010
 
 

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada)  Associate Professor, Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences; Senior Consultant in Pediatric Nephrology, Department of Nephrology and Transplant Medicine, Fortis Hospitals, India

Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada) is a member of the following medical societies: American Society of Pediatric Nephrology, Indian Academy of Pediatrics, International Society of Nephrology, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Deogracias Pena, MD  Medical Director of Dialysis, Department of Pediatrics, Cook Children's Medical Center; Clinical Associate Professor, Texas Tech University School of Medicine

Deogracias Pena, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and American Society of Pediatric Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard Neiberger, MD, PhD  Director of Pediatric Renal Stone Disease Clinic, Associate Professor, Department of Pediatrics, Division of Nephrology, University of Florida College of Medicine and Shands Hospital

Richard Neiberger, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Medical Association, American Society of Nephrology, American Society of Pediatric Nephrology, Christian Medical & Dental Society, Florida Medical Association, International Society for Peritoneal Dialysis, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Shock Society, Sigma Xi, Southern Medical Association, Southern Society for Pediatric Research, and Southwest Pediatric Nephrology Study Group

Disclosure: The Osler Institute Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Adrian Spitzer, MD  Clinical Professor Emeritus, Department of Pediatrics, Albert Einstein College of Medicine

Adrian Spitzer, MD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Pediatric Society, American Society of Nephrology, American Society of Pediatric Nephrology, International Society of Nephrology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Howard Trachtman, MD  Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine

Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD  The Isaac A Abt, MD, Professor of Kidney Diseases, Northwestern University, The Feinberg School of Medicine; Division Head of Kidney Diseases, Children's Memorial Hospital

Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology

Disclosure: Merck Grant/research funds None; NIH Grant/research funds None; Raptor Pharmaceuticals, Inc Grant/research funds None; Alexion Pharmaceuticals, Inc. Grant/research funds None

References

  1. Tu WH, Shortliffe LD. Evaluation of asymptomatic, atraumatic hematuria in children and adults. Nat Rev Urol. Apr 2010;7(4):189-94. [Medline].

  2. Higashihara E, Nishiyama T, Horie S, et al. Hematuria: definition and screening test methods. Int J Urol. Apr 2008;15(4):281-4. [Medline].

  3. Quigley R. Evaluation of hematuria and proteinuria: how should a pediatrician proceed?. Curr Opin Pediatr. Apr 2008;20(2):140-4. [Medline].

  4. Diven SC, Travis LB. A practical primary care approach to hematuria in children. Pediatr Nephrol. Jan 2000;14(1):65-72. [Medline].

  5. Dodge WF, West EF, Smith EH, Bruce Harvey 3rd. Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr. Feb 1976;88(2):327-47. [Medline].

  6. Crompton CH, Ward PB, Hewitt IK. The use of urinary red cell morphology to determine the source of hematuria in children. Clin Nephrol. Jan 1993;39(1):44-9. [Medline].

  7. Cruz CC, Spitzer A. When you find protein or blood in the urine. Contemp Pediatr. 1998;15:89-109.

  8. D'Amico G. The commonest glomerulonephritis in the world: IgA nephropathy. Q J Med. Sep 1987;64(245):709-27. [Medline].

  9. Emancipator SN, Gallo GR, Lamm ME. IgA nephropathy: perspectives on pathogenesis and classification. Clin Nephrol. Oct 1985;24(4):161-79. [Medline].

  10. Feld LG, Stapleton FB, Duffy L. Renal biopsy in children with asymptomatic hematuria or proteinuria: survey of pediatric nephrologists. Pediatr Nephrol. Aug 1993;7(4):441-3. [Medline].

  11. Feld LG, Waz WR, Perez LM, Joseph DB. Hematuria. An integrated medical and surgical approach. Pediatr Clin North Am. Oct 1997;44(5):1191-210. [Medline].

  12. Kalia A, Travis LB, Brouhard BH. The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children. J Pediatr. Nov 1981;99(5):716-9. [Medline].

  13. Kincaid-Smith P, Fairley K. The investigation of hematuria. Semin Nephrol. May 2005;25(3):127-35. [Medline].

  14. Krieger I, Sargent DA. A postural sign in the sensory deprivation syndrome in infants. J Pediatr. Mar 1967;70(3):332-9. [Medline].

  15. Meyers KE. Evaluation of hematuria in children. Urol Clin North Am. Aug 2004;31(3):559-73, x. [Medline].

  16. Roy S 3rd. Hematuria. Pediatr Rev. Jun 1998;19(6):209-12; quiz 213. [Medline].

  17. Sargent JD, Stukel TA, Kresel J, Klein RZ. Normal values for random urinary calcium to creatinine ratios in infancy. J Pediatr. Sep 1993;123(3):393-7. [Medline].

  18. Seigel M, Lee ML. Hematuria. Semin Arthritis Rheum. 1974;3:1.

  19. Ward JF, Kaplan GW, Mevorach R, et al. Refined microscopic urinalysis for red blood cell morphology in the evaluation of asymptomatic microscopic hematuria in a pediatric population. J Urol. Oct 1998;160(4):1492-5. [Medline].

  20. Yadin O. Hematuria in children. Pediatr Ann. Sep 1994;23(9):474-8, 481-5. [Medline].

 
Previous
Next
 
Approach to hematuria.
Nonglomerular hematuria.
Glomerular hematuria.
Microscopy of urinary sediment. Typical appearance in non-glomerular hematuria: RBCs are uniform in size and shape but show two populations of cells because a small number have lost their hemoglobin pigment.
Microscopy of urinary sediment. Typical appearance of RBCs in glomerular hematuria: RBCs are small and vary in size, shape, and hemoglobin content.
Microscopy of urinary sediment. A cast containing numerous erythrocytes, indicating glomerulonephritis.
Table. Histologic Findings
Condition Histology History Laboratory Data
Systemic lupus erythematosusMild glomerulitis, proliferative changes, immune complex deposition, crescents, immunoglobulin depositionHematuria, proteinuria, hypertension, joint pains, rashesAbnormal C3, C4, ANA, and dsDNA levels; anemia; thrombocytopenia
IgA nephropathyIgA deposition in the mesangium, glomerular sclerosis, proliferative changes, crescents in severe casesGross, intermittent, painless hematuriaNo specific changes, although increased serum



IgA levels observed in some patients



Henoch-Schönlein purpuraSame as IgA nephropathyPurpura, joint pains, abdominal pain, hematuriaNo specific laboratory data
Alport syndromeSome thinning of basement membranes, "basket weave" changes in the glomerular basement



membrane on electron microscopy



Sensorineural hearing loss, corneal abnormalities, hematuria, renal failureNo specific changes
Thin basement membrane diseaseAverage glomerular basement membranes reported to be 100-200 nm in children in this conditionPersistent microscopic or gross hematuria, significant family historyNo specific changes
Mesangiocapillary glomerulonephritisGlomerular lobulations, thickening of the mesangial matrix and glomerular basement membranes, crescentsHematuria, proteinuria, hypertensionC3 levels possibly abnormal
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.