Definition of Haematuria

Haematuria is the passage of blood in the urine.

abrot. Acon. alco. aloe alumn. am-c. ambr. amyg-p. ant-c. Ant-t. antip. APIS ARG-N. ARN. ARS. ars-h. ars-s-f. asc-t. aspar. Aur. aur-ar. aur-s. Bell. bell-p. benz-ac. Berb. borx. BOTH. bufo CACT. cadm-met. cadm-s. CALC. Camph. CANN-S. CANTH. Caps. Carb-ac. Carb-v. carbn-s. carc. Caust. chel. Chim. chin. Chinin-ar. chinin-s. chir-fl. cimic. cina COC-C. coch. Colch. coli. coloc. Con. Cop. crot-c. CROT-H. cub. cupr. cupr-s. cyn-d. dig. diosm. diph-t-tpt. dulc. epig. equis-h. Erig. eucal. euph. fab. ferr. Ferr-ar. ferr-m. ferr-p. fic-r. fuma-ac. gaert. gal-ac. ger. graph. guat. HAM. Hell. hep. hydrang. Hyper. IP. jatr-c. Kali-ar. kali-bi. Kali-chl. kali-i. kali-m. kali-n. kalm. Kreos. Lach. lat-m. led. loxo-lae. loxo-recl. Lyc. Mangi. Merc. MERC-C. Mez. MILL. moni. murx. Nat-m. nat-n. Nit-ac. Nux-v. oci. ol-sant. Op. opun-v. ox-ac. oxyurn-sc. pall. pareir. petr. Ph-ac. PHOS. pic-ac. Plb. psor. PULS. rhod. Rhus-a. Rhus-t. sabad. Sabin. sal-ac. santin. Sars. scarl. SEC. Senec. Sep. ser-ang. Solid. SQUIL. stigm. Sul-ac. Sulph. tab. tann-ac. tarent. TER. terebe. thal-xyz. Thlas. thuj. tril-p. tub. uva vac. vanad. vesp. vip. Zinc. zinc-p.

Types of Haematuria

Frank haematuria

It is the presence of blood on macroscopic examination.

Alumn. apis ars. bell. Cact. canth. Chim. coc-c. colch. Ip. kreos. Lyc. mela. Mill. Ph-ac. Plat. puls.

Microscopic haematuria

It indicates that RBCs are only seen on microscopy.

Acon. ant-t. apis ARN. ars. Ars-h. Berb. CACT. cadm-s. calc. cann-s. CANTH. caps. Carb-ac. Carb-v. cham. CHIM. chin. chinin-ar. chinin-s. colch. coloc. con. crot-h. Dulc. ferr-p. Ham. hell. hep. ip. kali-bi. Kali-chl. lyc. merc. mez. nat-n. Nit-ac. pareir. PH-AC. phos. pic-ac. PULS. santin. sec. SEP. sul-ac. sulph. Ter. uva Zinc.

Haemoglobinuria

It is defined as the presence of free Hb in the urine.

acon. act-sp. agar. all-c. alum. Am-c. am-caust. ant-c. ant-t. apis arg-n. ARN. ARS. ARUND. Aspar. aur-m. bapt. bell. Benz-ac. Berb. bry. Cact. Camph. Carb-v. Caust. chel. Chim. chin. chinin-ar. Chinin-s. Cimic. cob. coc-c. colch. Coloc. con. Cop. DIG. Elaps get. Glon. grat. hedeo. Hyos. Ip. Kali-c. kali-n. Lach. Led. LOB. LYC. Meph. MERC-C. Mez. Nat-m. Nat-s. nit-ac. nux-m. Nux-v. Oci. Op. ox-ac. pall. PAREIR. Petr. PHOS. pic-ac. PLAN. Psor. puls. pyrog. rumx. SEL. SENEC. SEP. Sil. sumb. TARENT. ter. thuj. valer. zinc. zinc-p.

Initial haematuria

When blood comes on commencing urination. It suggests a urethral cause.

con.

Terminal haematuria

When blood comes after passing urine. It suggests a bladder base or prostatic cause.

HEP. mez. puls. sars. sulph. Thuj.

Key Points for Haematuria

• Haematuria always requires investigation to exclude an underlying cause.
• Initial haematuria suggests a urethral cause.
• Terminal haematuria suggests a bladder base or prostatic cause.
• Ribbon clots suggest a pelvi-ureteric cause.
• Renal bleeding can mimic colic due to clots passing down the ureter.

Causes of Haematuria

Important Diagnostic Features of Haematuria

Kidney

Trauma: mild to moderate trauma commonly causes renal bleeding; severe injuries may not bleed (avulsed kidney- complete disruption).

acon. Arn. bell. verat-v.

Tumours: may be profuse or intermittent.

Anil.

Renal cell carcinoma: associated mass, loin pain, clot colic or fever, occasional polycythaemia, hypercalcaemia and hypertension.

calc. chim. form. sars. solid.

Transitional cell carcinoma (TCC): characteristically painless, intermittent haematuria.

agath-a. Aloe Am-c. Ant-c.Ant-t. CALC.Cann-s. cic. Con. Hell. heroin. hyos. Kreos. laur. Lyc. mosch. olnd. Op. Ph-ac. positr. psil. sacch. Sec. stram. Sulph. syph. tung-m.

Calculus: severe loin/groin pain, gross or microscopic, associated infection.

act-sp. alum. am-c. am-m. ambr. Ant-c. apoc. Arg-n. arn. baros. bell. bell-p. BENZ-AC. Berb. cact. cal-ren. CALC. Cann-xyz. Canth. cham. chin. chinin-s. Chlf. cimic. coc-c. coli. coloc. Dios. epig. equis-h. erig. ery-a. eup-pur. fab. frag. gali. guat. hed. hedeo. hep. hydrang. ipom-p. kali-bi. kali-c. kali-i. lach. lipp. LITH-C. Lith-f. Lith-met. Lith-p. LYC. mag-p. med. mill. morg-g. nat-m. Nit-ac. nux-m. nux-v. oci. onis. op. oxyd. PAREIR. Petr. Phos. pipe. polyg-h. rub-t. Ruta saroth. SARS. Sep. Sil. solid. Stigm. sulfa. sulph. Tab. ter. thlas. thuj. urt-u. uva vesi. Zinc.

Glomerulonephritis: usually microscopic, associated systemic disease (e.g. systemic lupus erythematosus (SLE)).

APIS eberth. streptoc.

Pyelonephritis: rare.

apis bals-p. benz-ac. berb. bry. coc-c. coli. ferr-m. kali-sula. lyc. morg-g. naphtin. nux-v. podo. puls. sars. syc. ter.

Renal tuberculosis (rare): sterile pyuria, weight loss, anorexia, Pyrexia of unknown origin (PUO), increased frequency of micturition day and night.

ARS. BELL. calc.Carc. chin-ars. Coli. HEP. kreos. Lach. led. LYC. Nat-m. NIT-AC. ox-ac. PHOS. psor. PULS. SENEC. SEP. SULPH. Tub. Vac. vanad. Zinc.

Polycystic disease (rare): palpable kidneys, hypertension, chronic renal failure.

kres.

Renal arteriovenous malformation or simple cyst (very rare): painless, no other symptoms.

Renal infarction (very rare): may be caused by an arterial embolus, painful tender kidney.

bacls-7. LAT-M. mand. prot.

Ureter

Calculus: severe loin/groin pain, gross or microscopic, associated infection.

apis Bell. Berb. canth. carb-an. hydrang. Lyc. oci. par. polyg-h. SARS. sep. ter. verat.

TCC: characteristically painless, intermittent haematuria, history of work in rubber or dye industries.

agath-a. Aloe Am-c. Ant-c. Ant-t. CALC.Cann-s. cic. Con. Hell. heroin. hyos. Kreos. laur. Lyc. mosch. olnd. Op. Ph-ac. positr. psil. sacch. Sec. stram. Sulph. syph. tung-m.

Bladder

Calculus: sudden cessation of micturition, pain in perineum and tip of penis.

all-s. Ambr. ant-c. ant-t. apoc. arg-n. ars. aspar. bell. BENZ-AC. BERB. bry. cact. cal-ren. CALC. Cann-s. CANTH. carb-v. card-m. Chin. Coc-c. Coch. coff-t. colch. coloc. cupr. dig. epig. equis-h. Eup-per. graph. hydrang. kali-c. Kalm. kreos. Lach. lipp. Lith-c. Lith-m. Lith-p. Lith-s. LYC. Meny. merc. Merc-c. mez. Mill. naja nat-m. nat-s. Nit-ac. Nux-m. Nux-v. oxyd. pall. Pareir. Petr. Phos. Puls. Raph. rhod. Ruta SARS. SEP. Sil. sul-ac. sulph. tarent. thuj. zinc.

TCC: characteristically painless, intermittent haematuria, history of work in rubber or dye industries.

Anil. arg-n. ars. blatta-o. chim. clem. con. congo-r. crot-h. equis-h. gamb. hydr. mal-ac. sabal sars. staph. tarax. TER. thuj. tor.

Acute cystitis: suprapubic pain, dysuria, frequency and bacteriuria.

acon. ant-t. apis ars. aspar. Bell. benz-ac. berb. Camph. camph-ac. Cann-s. Canth. caps. chim. con. Cop. Cub. dig. Dulc. elat. Equis-h. erig. Eucal. Eup-pur. fab. ferr-act. Ferr-p. Gels. hell. hydrang. hyos. lach. Merc-c. methyl. mez. nit-ac. nux-v. Ol-sant. Pareir. petros. pip-m. Pop. prun. Puls. sabal Sabin. sars. Saur. sep. Stigm. sulph. Ter. tritic. uva vesi.

Interstitial cystitis (rare): may be autoimmune, drug or radiation induced, frequency and dysuria common.

med.

Schistosomiasis (very rare): history of foreign travel, especially North Africa.

ant-t. ars. chin. ip.

Prostate

BPH: painless haematuria, associated obstructive symptoms, recurrent UTI.

PROSTATE GLAND - SWELLING - old people; in

aloe BAR-C. Benz-ac. Con. DIG. ferr-pic. Iod. nux-v. prost. Sabal SEL. Staph. sulph.

Carcinoma: rare.

bar-ox-suc. carc. chim. CON. Cop. crot-h. Iod. kali-cy. Lyc. naphthoq. plb. Psor. SABAL Scir. Sel. senec. Sil. staph. sulfonam. Sulph. THUJ. thymol.

Urethra

Trauma: blood at meatus, history of direct blow to perineum, acute retention.

ARN. bell-p. cham. CON. dulc. euphr. ham. hyper. lach. Nat-c. nat-m. phos. Puls. Rhus-t. samb. Sul-ac. sulph. Symph.

Calculus:rare.

coc-c.

Urethritis: rare.

Acon. agar. agn. anemps. apis ARG-N. Ars. Aur. aur-ar. bell. bov. Cact. calc-f. camph. cann-i. CANN-S. CANTH. caps. carb-ac. caust. Chim. Clem. Cop. Cub. cycl. dig. dor. dulc. ferr-p. Gels. gonotox. gran. Hep. hydr. kali-bi. kali-f. Kali-i. kola lith-c. lyc. lyss. mag-f. med. Merc. Merc-c. napht. nat-c. nit-ac. Nux-v. oci-sa. pareir. Petr. Petros. phys. pip-m. psor. puls. rham-f. Sabin. sars. staph. Sulph. sumb. syc. tab. TER. teucr. Thuj. yohim.

KEY INVESTIGATIONS for Haematuria

• Full Blood Count (FBC): infection, chronic blood loss. 'Rouleaux' suggest glomerulonephritis.
• Clotting: exclude underlying bleeding cause.
• Creatinine, Urea and electrolytes (U+E): renal function.
• Microscopic study of urine, microbe culture and sensitivity (MSU MC + S): infection, parasites.
• Renal cause: Intravenous pyelography (IVU), CT scan or Renal ultrasound (U/S) Renal Angiography for Arterio-Venous Malformation (AVM)
• Bladder cause: Cystoscopy, Renal U/S
• Glomerulonephritis: Autoimmune screen, Renal Biopsy (Bx)

References

• Although hematuria is absent in 5% to 10% of patients with genitourinary trauma,98...
  Principles of Critical Care > Chapter 95. Torso Trauma > Specific Abdominal Injuries-Diagnosis and Management Principles > Genitourinary Injuries
  
• Atraumatic Hematuria
  CURRENT Diagnosis & Treatment: Emergency Medicine > Chapter 37. Genitourinary Emergencies > Immediate Management of Serious & Life-Threatening Conditions
  
• Blood (Hematuria)
  Clinician's Pocket Reference > Chapter 6. Laboratory Diagnosis: Urine Studies > Differential Diagnosis for Routine Urinalysis
  
• Bloody Urine
  Smith's General Urology > Chapter 3. Symptoms of Disorders of the Genitourinary Tract > Symptoms Related to the Act of Urination
  
• Carcinoma of the Renal Pelvis and Ureter
  Harrison's Online > Chapter 90. Bladder and Renal Cell Carcinomas
  
• Colorless urine of low concentration from excessive fluid...
  DeGowin's Diagnostic Examination > Chapter 10. The Urinary System > Urinary System Signs > Key Sign Discolored Urine > DISCOLORED URINE-CLINICAL OCCURRENCE
  
• Diseases of glomeruli (glomerulonephritis or vasculitis) and the renal microvasculature (hemolytic...
  Harrison's Online > Chapter 45. Azotemia and Urinary Abnormalities > Azotemia > Approach to the Patient: Azotemia > Intrinsic Renal Disease
  
• Dysuria Associated with Hematuria in Either Sex
  CURRENT Diagnosis & Treatment: Emergency Medicine > Chapter 37. Genitourinary Emergencies > Immediate Management of Serious & Life-Threatening Conditions > Dysuria > Clinical Findings
  
• Erythrocytes
  Smith's General Urology > Chapter 5. Urologic Laboratory Examination > Examination of Urine > Interpretation
  
• Exercise 9-4. Hematuria
  Basic Radiology, 2e > Chapter 9. Radiology of the Urinary Tract
  
• Figure 45-2. Approach to the patient with hematuria. RBC, red blood cell; WBC, white blood...
  Harrison's Online > Chapter 45. Azotemia and Urinary Abnormalities > Azotemia > Approach to the Patient: Azotemia > Intrinsic Renal Disease
  
• Gastrointestinal Bleeding, Hemoptysis, and Hematuria
  Hazzard's Geriatric Medicine and Gerontology, 6e > Chapter 106. Hemorrhagic Disorders > Clinical Approach to Bleeding in the Elderly Patient > Bleeding Symptoms
  
• Hematuria & Glomerular Disease
  CURRENT Diagnosis & Treatment: Pediatrics > Chapter 22. Kidney & Urinary Tract
  
• Hematuria & Renal Papillary Necrosis
  CURRENT Diagnosis & Treatment: Nephrology & Hypertension > Chapter 49. Sickle Cell Nephropathy
  
• Hematuria can also occur with papillary necrosis, a complication seen in both homozygous and...
  Tintinalli's Emergency Medicine > Chapter 135. Sickle Cell Disease > GU Complaints
  
• Hematuria is considered the hallmark finding in GU trauma, although it is a nonspecific sign. ...
  Tintinalli's Emergency Medicine > Chapter 251. Trauma in Children > Specific Pediatric Injuries > Pelvic and GU Trauma
  
• Hematuria
  Clinician's Pocket Reference > Chapter 3. Differential Diagnosis: Symptoms, Signs, and Conditions
  
• Hematuria
  CURRENT Diagnosis & Treatment: Nephrology & Hypertension > Chapter 1. Approach to the Patient with Renal Disease > Complications
  
• Hematuria
  CURRENT Diagnosis & Treatment: Surgery, 13e > Chapter 38. Urology > Acquired Lesions of the Genitourinary Tract
  
• Hematuria
  CURRENT Medical Dx & Tx > Chapter 22. Kidney Disease > Approach to Kidney Disease > Urinalysis
  
• Hematuria
  CURRENT Medical Dx & Tx > Chapter 22. Kidney Disease > Cystic Diseases of the Kidney > Autosomal Dominant Polycystic Kidney Disease > Complications & Treatment
  
• Hematuria
  CURRENT Medical Dx & Tx > Chapter 23. Urologic Disorders > Urologic Evaluation > History
  
• Hematuria
  CURRENT Medical Dx & Tx > Chapter 23. Urologic Disorders
  
• Hematuria
  Diagnosaurus
  
• Hematuria
  Hazzard's Geriatric Medicine and Gerontology, 6e > Chapter 127. Urinary Tract Infections > Clinical Presentation
  
• Hematuria
  Smith's General Urology > Chapter 16. Urinary Stone Disease > Renal & Ureteral Stones > Symptoms & Signs at Presentation
  
• Hematuria
  Tintinalli's Emergency Medicine > Chapter 128. Renal Emergencies in Infants and Children
  
• Hematuria
  Tintinalli's Emergency Medicine > Chapter 230. Hemophilias and von Willebrand Disease > Hemophilia > Special Considerations
  
• Hematuria
  Tintinalli's Emergency Medicine > Chapter 94. Urinary Tract Infections and Hematuria
  
• Hematuria
  Williams Hematology, 8e > Chapter 124. Hemophilia A and Hemophilia B > Hemophilia A (Classic Hemophilia, Factor VIII Deficiency) > Clinical Features
  
• Hematuria
  Williams Hematology, 8e > Chapter 48. Disorders of Hemoglobin Structure: Sickle Cell Anemia and Related Abnormalities > Clinical Features and Management > Genitourinary
  
• Hematuria, Cyst Hemorrhage, and Retroperitoneal Hemorrhage
  CURRENT Diagnosis & Treatment: Nephrology & Hypertension > Chapter 46. Cystic Diseases of the Kidney > Autosomal Dominant Polycystic Kidney Disease > Clinical Findings > Symptoms and Signs > Renal Manifestations
  
• Hematuria, Proteinuria, and Pyuria
  Harrison's Online > Chapter 277. Glomerular Diseases > Approach to the Patient: Glomerular Disease
  
• Hematuria, Pyuria, and Casts
  Harrison's Online > Chapter 45. Azotemia and Urinary Abnormalities > Abnormalities of the Urine
  
• HEMATURIA-CLINICAL OCCURRENCE
  DeGowin's Diagnostic Examination > Chapter 10. The Urinary System > Urinary System Signs > Key Sign Discolored Urine
  
• Normally, erythrocytes, leukocytes, hyaline casts, and crystals (urate, phosphate, oxalate) are...
  DeGowin's Diagnostic
  
• Renal
  CURRENT Diagnosis & Treatment: Nephrology & Hypertension > Chapter 47. Familial Hematurias: Alport Syndrome & Thin Basement Membrane Nephropathy > Alport Syndrome > Clinical Findings > Symptoms and Signs
  
• The classic symptom complex for nephrolithiasis is the acute onset of a crampy intermittent pain...
  Tintinalli's Emergency Medicine > Chapter 97. Urologic Stone Disease > Clinical Features
  
• The signs and symptoms of acute appendicitis lie along a spectrum that correlates with...
  Tintinalli's Emergency Medicine > Chapter 84. Acute Appendicitis > Clinical Features
  
• Urinalysis
  Williams Obstetrics, 23e > Chapter 5. Maternal Physiology > Urinary System > Kidney
  
• Encyclopedia Homoeopathica
  
• Radar 10