Isolated and persistent glomerular hematuria: IgA; Alport; thin basement membrane nephropathy
- Clifford E Kashtan, MD
Clifford E Kashtan, MD
- Professor of Pediatrics
- Director, Division of Pediatric Nephrology
- University of Minnesota Medical School
- Executive Director
- Alport Syndrome Treatments and Outcomes Registry (ASTOR)
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- Fernando C Fervenza, MD, PhD
Fernando C Fervenza, MD, PhD
- Section Editor — Glomerular Diseases
- Professor of Medicine
- Mayo Clinic College of Medicine
Hematuria is a common finding in glomerular diseases. In the patient with persistent hematuria, dysmorphic red cells and red cell casts suggest the presence of a glomerular disease, as does the presence of albuminuria. (See "Etiology and evaluation of hematuria in adults", section on 'Glomerular versus nonglomerular bleeding' and "Assessment of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults", section on 'Types of proteinuria'.)
Patients with glomerular hematuria often have other abnormalities, including proteinuria, edema, hypertension, and impaired glomerular filtration rate. However, in some patients the only manifestation of glomerular disease is persistent hematuria, similar to that seen with extraglomerular causes of bleeding such as prostatic disease and stones.
The definition and evaluation of isolated and persistent glomerular hematuria are discussed in this topic. The overall etiology and evaluation of hematuria in adults and the differential diagnosis of glomerular disease in adults are presented separately. (See "Etiology and evaluation of hematuria in adults" and "Differential diagnosis and evaluation of glomerular disease".)
The patient should initially be reexamined over a period of weeks to months to ascertain that the hematuria is persistent. Transient hematuria is a relatively common finding over time in adults and may be induced by factors such as exercise or infection. (See "Etiology and evaluation of hematuria in adults" and "Exercise-induced hematuria".)
Signs of glomerular bleeding (best identified by a nephrologist or other experienced examiner) include a dysmorphic appearance of some red cells, red cell casts and, in patients with gross hematuria, a brown, cola-colored urine (table 1 and picture 1A-C). (See "Etiology and evaluation of hematuria in adults", section on 'Glomerular versus nonglomerular bleeding'.)
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