alt=Hematuria can be classified according to visibility, anatomical origin, and timing of blood during urination. * In terms of the visibility, hematuria can be visible to the naked eye (termed "gross hematuria") and may appear red or brown (sometimes referred to as tea-colored), or it can be microscopic (i.e. not visible to the eye but detected with a microscope or laboratory test). Microscopic hematuria is present when there are three of more red blood cells per high power field. * In terms of the anatomical origin, blood or red blood cells can enter and mix with urine at multiple anatomical sites within the urinary system, including the kidney, ureter, urinary bladder, and urethra, and in men, the prostate. Additionally, menstruation in women may cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. The causes corresponding to these anatomic locations can be divided into glomerular and non-glomerular causes, referring to the involvement of the glomerulus of the kidney. Non-glomerular causes can be further subdivided into upper urinary tract and lower urinary tract causes. * In terms of the timing during urination, hematuria can be initial, terminal or total, meaning blood can appear in the urine at the onset, midstream, or later. If it appears soon after the onset of urination, a distal site is suggested. A longer delay suggests a more proximal lesion. In other words, shorter times suggest distal sites while longer times suggest proximal sites. Hematuria that occurs throughout urination suggests that bleeding is occurring above the level of the bladder. Many causes may present as either visible hematuria or microscopic hematuria, and so the differential diagnosis is frequently organized based upon glomerular and non-glomerular causes. Glomerular hematuria Postrenal hematuria - the presence of blood in urine (because of damage to the urethra and prostate). Glomerular causes include: * IgA nephropathy * Thin glomerular basement membrane disease * Hereditary nephritis (Alport's disease) * Hemolytic uremic syndrome * Postinfectious glomerulonephritis * Membranoproliferative glomerulonephritis * Lupus nephritis * Henoch-Shonlein purpura *Nephritic syndrome *Nephrotic syndrome * Polycystic kidney disease *Idiopathic hematuria Non-glomerular hematuria Visible blood clots in the urine indicate a non-glomerular cause. Non-glomerular causes include: * Urinary tract infections, such as pyelonephritis, cystitis, prostatitis, and urethritis * Kidney stones * Cancers, such as renal cell carcinoma and bladder cancer, and in men, prostate cancer * Urinary tract strictures * Benign prostatic hyperplasia * Renal papillary necrosis * Trauma or damage to the lining of the urinary tract * Intense exercise * Increased tendency to bleed due to acquired or genetic conditions (e.g. sickle cell disease or vitamin K deficiency bleeding) or certain medications (e.g. blood thinners) Mimickers of hematuria Pigmenturia Not all red or brown urine is caused by hematuria. Other substances such as certain medications and certain foods can cause urine to appear red. Medications that may cause urine to appear red include: * Phenazopyridine * Nitrofurantoin * Doxorubicin * Rifampicin Foods that may cause urine to appear red include: * Blackberries * Food dyes. * Beets * Rhubarb False positive urine dipstick A urine dipstick may be falsely positive for hematuria due to other substances in the urine. While the urine dipstick test is able to recognize heme in red blood cells, it also identifies free hemoglobin and myoglobin. Free hemoglobin may be found in the urine resulting from hemolysis, and myoglobin may be found in the urine resulting from rhabdomyolysis. Thus, a positive dipstick test does not necessarily indicate hematuria; rather, microscopy of the urine showing three of more red blood cells per high power field confirms hematuria. Menstruation In women, menstruation may cause the appearance of hematuria and may result in a urine dipstick test positive for hematuria. Menstruation can be ruled out as a cause of hematuria by inquiring about menstruation history and ensuring the urine specimen is collected without menstrual blood.
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