What is the relationship between hematuria and sickle cell disease (SCD)?

Updated: Sep 12, 2019
  • Author: Phuong-Thu Pham, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Painless hematuria (microscopic, macroscopic, or gross) is a common symptom of sickle cell disease (SCD). Bleeding is usually mild and typically remits spontaneously within a few days.

The left kidney is affected four times more than the right due to the increased venous pressure within the longer left vein that is compressed between the aorta and the superior mesenteric artery, the so-called nutcracker phenomenon. The increased venous pressure leads to increased relative hypoxia in the renal medulla, hence sickling. Bilateral hematuria occurs in approximately 10% of cases.

Although renal papillary necrosis typically presents as painless gross hematuria, it may be complicated by obstructive uropathy and urinary tract infections. Renal medullary carcinoma is an uncommon cause of gross hematuria.

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