causes of your problem::
Trauma: › Exercise-induced (resolves with rest)
› Abdominal trauma and/or pelvic fracture with renal, bladder, or ureteral injury
› Iatrogenic from abdominal or pelvic surgery;
chronic indwelling catheters
› Foreign body, physical/sexual abuse
• Neoplasms: › Malignancies: 30% of adult patients with painless, gross hematuria and ~10% with painless
microscopic hematuria have a malignancy (2).
Urothelial carcinoma of the bladder and renal tumors are of greatest concern in adults.
› Benign tumors
› Endometriosis of the urinary tract (suspect in females with cyclic hematuria)
• Inflammatory causes: › UTI: Most common cause of hematuria in adults
› Renal diseases: Radiation nephritis, radiation cystitis, acute and chronic tubulointerstitial nephritis (due to drugs, infections, systemic disease)
› Glomerular disease: – Goodpasture syndrome (antiglomerular basement membrane disease; autoimmune; associated
pulmonary hemorrhage)
– IGA nephropathy
– Lupus nephritis
– Henoch-Schönlein purpura
– Membranoproliferative, poststreptococcal, or
rapidly progressive glomerulonephritis
– Wegener granulomatosis
› Endocarditis/visceral abscesses
› Other infections: Schistosomiasis, TB, syphilis
• Metabolic causes: › Calculus disease (85% of patients have hematuria): – Hypercalciuria: A common cause of both gross and microscopic hematuria in children (1)
– Hyperuricosuria
• Congenital/Familial causes: › Cystic disease: Polycystic kidney disease, solitary renal cyst
› Benign familial hematuria or thin basement membrane nephropathy (autosomal dominant)
› Alport syndrome (X-linked in 85%; hematuria, proteinuria, hearing loss, corneal abnormalities) (4)
› Fabry disease (X-linked recessive inborn error of metabolism; vascular kidney disease)
› Nail-patella syndrome (autosomal dominant; nail and patella hypoplasia; hematuria in 33%)
›
Renal tubular acidosis type 1 (autosomal dominant or autoimmune)
• Hematologic causes: › Bleeding dyscrasias (e.g., hemophilia)
› Sickle cell anemia/trait (
renal papillary necrosis)
• Vascular causes: › Hemangioma
› Arteriovenous malformations (rare)
› Nutcracker syndrome: Compression of left renal vein and subsequent renal parenchymal congestion
› Renal artery/vein thrombosis
› Arterial emboli to kidney
• Chemical causes: › Nephrotoxins: Aminoglycosides, cyclosporine
› Other drugs: Analgesics, oral contraceptives, Chinese herbs
• Obstruction: › Strictures or posterior urethral valves
› Hydronephrosis, from any cause
› Benign prostatic hyperplasia: Rule out other causes of hematuria.