What is included in the physical exam to evaluate 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

Physical examination should include the following:

  • Measurement of the blood pressure (with an appropriately sized cuff)

  • Evaluation for the presence of periorbital puffiness or peripheral edema

  • Detailed skin examination to look for purpura and/or petechiae.

  • Abdominal examination to look for palpable kidneys

  • Careful examination of the genitalia

  • Detailed ophthalmologic evaluation (in familial hematuria)

The following findings help distinguish between glomerular and nonglomerular hematuria:

  • Glomerular hematuria: Brown-colored urine, RBC casts, and dysmorphic (small, deformed, misshapen, sometimes fragmented) RBCs and proteinuria

  • Nonglomerular hematuria: Reddish or pink urine, passage of blood clots, and eumorphic (normal-sized, biconcavely shaped) erythrocytes

See Clinical Presentation for more detail.


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