Hematuria: diagnostic approach

What is it?

Hematuria is the presence of blood in the urine.

It can be:

Gross: visible to the naked eye.

Microscopic: detected by urinalysis and confirmed by microscopic evaluation.

What should we ask?

• Is it visible?
• Are there clots?
• Is there pain?
• Is there fever?
• Are there urinary symptoms?
• Is there a history of stone disease?
• Does or did the patient smoke?
• Is the patient taking anticoagulants?
• Is there a history of urinary tract tumors?

Hematuria with pain

It can occur, among other situations, in association with:

• stone disease;
• infection;
• trauma.

Painless hematuria

Painless gross hematuria, especially in an adult, requires ruling out a urinary tract neoplasm.

Evaluation

Depending on age, characteristics, and risk factors, the following may be used:

• urinalysis;
• renal function;
• imaging studies;
• cystoscopy;
• other targeted tests.