What is the focus of clinical history for the evaluation of hematuria?

Updated: Jan 03, 2019
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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Answer

The first step in the evaluation of hematuria consists of a detailed history and a thorough physical examination. Efforts should be made to distinguish glomerular causes from extraglomerular ones, as follows:

  • Passage of clots in urine suggests an extraglomerular cause

  • Fever, abdominal pain, dysuria, frequency, and recent enuresis in older children may point to a urinary tract infection as the cause

  • Recent trauma to the abdomen may be indicative of hydronephrosis

  • Early-morning periorbital puffiness, weight gain, oliguria, dark-colored urine, and edema or hypertension suggest a glomerular cause

  • Hematuria due to glomerular causes is painless

  • Recent throat or skin infection may suggest postinfectious glomerulonephritis

  • Joint pains, skin rashes, and prolonged fever in adolescents suggest a collagen vascular disorder

  • Anemia cannot be accounted for by hematuria alone; in a patient with hematuria and pallor, other conditions should be considered

  • 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 diagnosis

  • A family history that is suggestive of Alport syndrome, collagen vascular diseases, urolithiasis, or polycystic kidney disease is important


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