Hematuria is the presence of blood in a person’s urine. The two types of hematuria are gross hematuria—when a person can see the blood in his or her urine microscopic hematuria—when a person cannot see the blood in his or her urine, yet it is seen under a microscope

1. Hematuria
By
Salam Khassaf

2. What is hematuria?
• Hematuria is the prescience of red blood cells
(RBCs) in the urine, specifically > 5 RBCs/HPF on
urine sediment.

3. Classification of hematuria
• According to the amount of RBC can hematuria can be
classified as:
Macroscopic hematuria
(visible or gross)
* Urine color can be red,
tea, cola-color or even
pink.
Microscopic hematuria
(under microscope)
• Urine color can
normal with the naked
eye.

4. Classification by timing
• When it occurs during urination, is very important; it
may indicate the location of the problem.
• Initial hematuria, at the onset of urination (urethra).
• Terminal hematuria, at the end of urination (Bladder
or Prostate in men).
• Total hematuria, Passage of blood throughout the
entire micturition. Suggests damage to the bladder
neck, ureters or kidneys (e.g., urolithiasis, UTI).

5. Sources and sites of hematuria

6. Causes of hematuria
Extra-renal
• Stones (ureters,
bladders or urethra).
• Cystitis.
• Trauma.
• Coagulopathy.
• Tumors of lower tract.
• Urinary tract infection.
• Parasites (Bilharziasis)
Renal
• Glomerulonephritis
(IgA nephropathy, Post-
streptococcal GN).
• Hypercalcuria
• Vasculitis
• Polycystic kidney
disease.
• Tumors.
• Pyelonephritis.
• Renal vein thrombosis.
Others
• Drugs:
(Rifampicin,
phenazopyridine and
azathioprine).
• Foods:
Several foods can
causes urine to turn red
or pink in color (e.g.
beets, rhubarb, and
blackberries).

7. Urine dipstick test
When the test is positive, it does not mean
an accurate diagnosis of hematuria !!
• Dipstick positive + RBCs on
microscopic UA = Hematuria.
• Dipstick positive + low or absent RBCs
on microscopic UA = Hemoglobinuria
or myoglobinuria

8. Hematuria, hemoglobinuria, and
myoglobinuria ?

9. Hemoglobinuria
Hemoglobinuria is a condition in which the oxygen transport protein
hemoglobin is found in abnormally high concentrations in the urine.

10. Myoglobinuria
Myoglobinuria is a condition in which myoglobin, a substance that stores oxygen within
the muscles, spills into the blood and urine.
This condition, which primarily occurs as a result of muscle damage (Rhabdomyolysis),
can also occur as an inherited metabolic defect or may follow heavy exercise, injury, or
toxic damage from drugs or chemicals.

11. Pathognomonic
Red Blood Cell casts are pathognomonic of the renal origin of hematuria.

12. RBC morphology
Isomorphic RBC
Non-glomerular
(Renal, ureters and bladders)
Dysmorphic RBC (different shape and
size)
Glomerular bleeding (GN)

13. RBC morphology
Dysmorphic RBCs have odd shapes as a consequence of being
distorted via squeeze through the glomerular structure .

14. Algorithm to the diagnosis of red urine
Red urine
-ve dipstick
+ve dipstick
No RBCs
RBCs
Isomorphic
RBCs
Dysmorphic
RBCs
Glomerular
hematuria
Non-glomerular
hematuria Hemoglobinuria or
myoglobinuria
Foods or
drugs

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