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Etiology and evaluation of hematuria in adults

Michael Kurtz, MD
Adam S Feldman, MD, MPH
Mark A Perazella, MD, FACP
Section Editors
Richard J Glassock, MD, MACP
Michael P O'Leary, MD, MPH
Jorge A Soto, MD
Deputy Editors
Albert Q Lam, MD
Susanna I Lee, MD, PhD


Hematuria that is not explained by an obvious underlying condition (eg, cystitis, ureteral stone) is fairly common. In many such patients, particularly young adult patients, the hematuria is transient and of no consequence [1]. On the other hand, there is an appreciable risk of malignancy in older patients (eg, over age 35 years) with hematuria, even if transient [2-4]. However, even among older patients, a urologic cause for the hematuria can often not be identified (61 percent in a series of 1930 patients referred to a hematuria clinic) [2]. (See 'Transient or persistent hematuria' below.)

The etiology and evaluation of hematuria in adults will be reviewed here (figure 1 and algorithm 1). The approach in children is discussed separately. (See "Evaluation of microscopic hematuria in children" and "Evaluation of gross hematuria in children".)


Hematuria may be visible to the naked eye (called gross hematuria) or detectable only on examination of the urine sediment by microscopy (called microscopic hematuria).

Gross hematuria — Gross hematuria is suspected because of the presence of red or brown urine. The color change does not necessarily reflect the degree of blood loss, since as little as 1 mL of blood per liter of urine can induce a visible color change. In addition, the intermittent excretion of red to brown urine can be seen in a variety of clinical conditions other than bleeding into the urinary tract (see "Urinalysis in the diagnosis of kidney disease", section on 'Red to brown urine'). Gross hematuria with passage of clots usually indicates a lower urinary tract source but can be seen with some forms of intrarenal bleeding (eg, kidney cancer, immunoglobulin A [IgA] nephropathy).

As contamination with blood is a possibility in menstruating and postpartum women, urine for analysis is best obtained when the other cause of bleeding has ceased. If this is not possible, a tampon can be inserted, and urinalysis can be obtained after the perineum is cleansed.

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Literature review current through: Nov 2017. | This topic last updated: Nov 21, 2017.
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