Hematuria differential diagnosis
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Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [1]
Differentiating Hematuria from other Diseases
Gross hematuria(GH) must be distinguished from pigmenturia, which may be due to endogenous sources (e.g., bilirubin, myoglobin, porphyrins), foods ingested (e.g., beets and rhubarb), drugs (e.g., phenazopyridine), and simple dehydration. This distinction can be made easily by urinalysis with microscopy. Notably, myoglobinuria and other factors can cause false-positive chemical tests for hemoglobin, so urine microscopy is required to confirm the diagnosis of hematuria. GH also must be distinguished from vaginal bleeding in women, which usually can be achieved by obtaining a careful menstrual history, collecting the specimen when the patient is not having menstrual or gynecologic bleeding, or, if necessary, obtaining a catheterized specimen. GH may also be detected by the presence of blood spotting on the undergarments of incontinent patients. After ruling out vaginal bleeding and mimics of hematuria, a urologic source must be suspected.
Red discoloration of the urine can have various causes:
- Red blood cells
- Microscopic hematuria (small amounts of blood, can be seen only on urinalysis or light microscopy)
- Macroscopic hematuria (or "frank" or "gross") hematuria
- Hemoglobin (only the red pigment, not the red blood cells)
- Other pigments
- Porphyrins in porphyria
- Betanin, after eating beets
Differentiating Hemoglobinuria from Myoglobinuria
| Centrifuse Result | |||||||||||||||||||||||||||||||||||||||||||
| Sediment Red | Supernatant Red | ||||||||||||||||||||||||||||||||||||||||||
| Hematuria | Dipstick heme | ||||||||||||||||||||||||||||||||||||||||||
| Negative | Positive | ||||||||||||||||||||||||||||||||||||||||||
| ❑ Beeturia ❑ Phenazopyridine ❑ Porphyria ❑ Other | ❑ Myoglobin ❑ Hemoglobin | ||||||||||||||||||||||||||||||||||||||||||
| Plasma color | |||||||||||||||||||||||||||||||||||||||||||
| Clear | Red | ||||||||||||||||||||||||||||||||||||||||||
| Myoglobinuria | Hemoglobinuria | ||||||||||||||||||||||||||||||||||||||||||