The first step, determination of hematuria
★Microscopic hematuria: RBC>3/HP or RBC>100,000/hr or Addis’ RBC>500,000/12hr after centrifugation
★Naked eye hematuria: blood>1ml/1L urine
Step 2: Exclude pseudohematuria
★Hemoglobinuria/Myoglobinuria: red meatus hematuria, RBC(+),but RBC(-)
★Drug influence: rifampin, aminopyrine, certain pigments, RBC(-),RBC(-)
★Menstrual blood mixed in: female patients should be questioned carefully to avoid confusion
Step 3: Local diagnosis of hematuria
★ urine three cup test: ① starting hematuria: urethra
②End hematuria: bladder neck, triangle or prostate in the posterior urethra
③Total hematuria: ureter or kidney
★ phase difference microscopy: ① glomerulogenic hematuria: abnormal RBC ≥ 80G and count > 10,000/ml
②Non-glomerular source hematuria: abnormal RBC≤50G and count>10,000/ml
③Mixed hematuria: abnormal RBC50G-80G and count>10,000/ml
★Urine red blood cell distribution volume: ①Glomerulogenic hematuria: asymmetric curve
②Non-glomerular-derived hematuria: symmetrical curve
③Mixed hematuria: bimodal curve
★Cystoscopy: It can directly observe the bleeding site and is an invasive test
★B ultrasound: it can check urinary stones, tumors, malformations and cysts, and is a non-invasive examination
★X-ray: Plain film/IVP, can detect urinary stones, tumors, malformations
★CT/MRI: to evaluate the nature of the mass, better
★Renal angiography: can determine renal vascular disease, renal occupational disease
★Kidney biopsy: can detect secondary diseases
Step 4: Qualitative diagnosis of hematuria
★Renal and urinary tract diseases: ①Inflammation: acute and chronic diseases, various interstitial nephritis, IgAN, RPGN, various interstitial nephritis, hereditary nephritis, thin basement membrane syndrome
②Infection: pyelonephritis, cystitis
③Stone: kidney, ureteral and bladder stones
④Tuberculosis: renal, ureteral and bladder tuberculosis
⑤ Tumor: kidney and bladder tumor
(6) Trauma: renal contusion, ureteral injury, urethral contusion
(vii) Malformation: polycystic kidney, renal artery stenosis, urethral diverticulum, nutcracker syndrome
⑧ Drugs: CTX, NSAIDs, mannitol, heavy metals, anticoagulants
★Adjacent organ disease: prostatitis, acute pelvic inflammatory disease/abscess, tubal inflammation, acute appendicitis
cervical cancer, colorectal cancer
★ systemic diseases: ① infectious diseases: sepsis, scarlet fever, epidemic hemorrhagic fever
② Hematologic diseases: hemophilia, leukemia, reocclusion, ITP
③Rheumatic diseases: SLE, SSc, dermatomyositis
④Cardiovascular diseases: acute hypertension, CHF, SLE, renal artery stenosis, renal vein thrombosis
★Functional hematuria: motility hematuria, “idiopathic hematuria”