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Hematuria Clinical
Presentation
Updated: May 10, 2020  |  Author: Sanjeev Gulati, MD,
MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN,
FRCPC(Canada); Chief Editor: Craig B Langman, MD 
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History
The first step in the evaluation of hematuria is a
detailed review of the history and a thorough
physical examination.

The presence or absence of hypertension or

proteinuria helps to decide how extensively to
pursue the diagnostic evaluation. The initial
evaluation should be directed toward important
and potentially life-threatening causes of
hematuria in any child who has any of the
following in addition to hematuria: hypertension,
edema oliguria, significant proteinuria (more
than 500 mg per 24 hours), or RBC casts. An
attempt should be made to distinguish
glomerular causes of hematuria from
extraglomerular ones, as this helps in
prioritizing the investigations.

A history of passage of clots in urine

suggests an extraglomerular cause of
hematuria.

A history of fever, abdominal pain, dysuria,

frequency, and recent enuresis in older
children may point to a urinary tract
infection as the cause of hematuria.

A history of recent trauma to the abdomen

may be indicative of hydronephrosis.

A history of early-morning periorbital

puffiness, weight gain, oliguria, the
presence of dark-colored urine, and the
presence of edema or hypertension
suggests a glomerular cause.

Hematuria due to glomerular causes is

painless.

A history of a recent throat or skin infection

may suggest postinfectious
glomerulonephritis.

A history of joint pains, skin rashes, and

prolonged fever in adolescents suggests a
collagen vascular disorder.

The presence of anemia cannot be

accounted for by hematuria alone, and, in
a patient with hematuria and pallor, other
conditions such as systemic lupus
erythematosus and bleeding diathesis
should be considered. [5]

Skin rashes and arthritis can occur in

Henoch-Schönlein purpura and systemic
lupus erythematosus.

Information regarding exercise,

menstruation, recent bladder
catheterization, intake of certain drugs or
toxic substances, or passage of a calculus
may also assist in the differential
diagnoses.

Because certain diseases that present with

hematuria are inherited or familial, asking
for a family history that is suggestive of
Alport syndrome, collagen vascular
diseases, urolithiasis, or polycystic kidney
disease is important.

Physical Examination
In the general physical examination, the most
important step is to measure the blood pressure
(with an appropriate-sized cuff) and evaluate for
the presence of periorbital puffiness or
peripheral edema. [6, 7]

A detailed skin examination is necessary to

look for purpura.

An abdominal examination is indicated to

look for palpable kidneys (Wilms tumor or
hydronephrotic kidneys).

A careful examination of the genitalia is

also important.

A detailed ophthalmological evaluation is

helpful in familial hematurias.

Differential Diagnoses

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