Differential diagnosis of hematuria

1. Big picture

Hematuria = blood in the urine. In an exam, the main task is not only to list causes, but to answer:

Is the bleeding glomerular, renal non-glomerular, or urological?

This decides the referral pathway:

Red urine
  ↓
Confirm true hematuria by microscopy
  ↓
RBC morphology + proteinuria + casts?
  ↓
Glomerular → nephrology
Non-glomerular/urological → urology

The dangerous diagnoses not to miss are:

• Urothelial/bladder cancer
• Renal cell carcinoma
• Nephritic syndrome / rapidly progressive glomerulonephritis
• Infected obstructing stone
• Trauma
• Severe anticoagulant-related bleeding
• Papillary necrosis
• Tuberculosis or schistosomiasis in the right context

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