hematuria
Hematuria may signal underlying disease of the renal parenchyma or genitourinary tract. Inflammation or infection of the bladder or prostate is the most common cause; kidney stones, malignancy, and glomerular disease account for most of the remaining cases. The patient’s history, medication profile, and pattern of hematuria all yield diagnostic clues.
Include a review of the patient’s medication profile in the initial examination. Hematuria can sometimes be caused by antibiotics, NSAIDs, chemotherapeutic agents, or anticoagulants.
If a glomerular disease is suspected, measuring serum complement levels may help establish the diagnosis. Lower levels are associated with such conditions as systemic lupus erythematosus and postinfectious glomerulonephritis.
Hematuria may occur in a patient being treated with anticoagulants, but this situation requires further evaluation.
Isolated asymptomatic hematuria warrants a genitourinary tract evaluation, especially in older patients. The evaluation may include renal x-rays, cystoscopy, urine cytology, and other tests.
In younger patients, periodic reevaluation of microscopic hematuria with urinalysis is probably sufficient.
