Last month, a 28-year-old female patient came to my clinic because of a physical examination that revealed hematuria. I performed a detailed examination on her and found blood pressure of 140/90 mmHg, urine red blood cells of 10/HP, red blood cell aberration rate of 80%, and urine protein quantification of 1.2 g/24 hours. She was considered to be admitted for chronic glomerulonephritis and renal hypertension, and her hematuria was renal hematuria. After careful review of her previous physical examination records upon admission, it was found that she had problems with urinalysis a year ago, when she had urine protein 2+, no hematuria, and no hypertension. Later, the urine routine was rechecked twice and the urine protein was 1~2+. I asked her if she knew that she had kidney problems a year ago, and she said she knew, and the physical examination report reminded her, but she didn’t take it seriously. I asked her again why she took it seriously this time, and she said that this time she found hematuria and felt scared, so she came to see a doctor. It turned out that she thought hematuria was scarier than proteinuria. According to her condition, I gave her a renal puncture for renal histopathology, and the result was IgA nephropathy, fortunately, the glomerulus was not sclerotic yet. Treatment such as hormone + ARB was given, and when she was rechecked after discharge, the urine protein had dropped to 0.3g/24 hours, and her blood pressure was normal. So, which is scarier, hematuria or proteinuria? Of course, both are scary. Proteinuria, hematuria and hypertension are the three major symptoms of glomerulonephritis, also known as nephritis syndrome, however, not all three symptoms of chronic nephritis appear. I list the following facts: Simple nephrogenic hematuria (red blood cells from the kidneys) No proteinuria, no hypertension, commonly seen in occult glomerulonephritis, or familial thin basement membrane nephropathy, etc. Both of these conditions can be treated without treatment and are OK with just regular review. Urine protein quantification Urine protein quantification is an important indicator to determine the severity of nephritis. It is generally believed that the greater the urine protein quantification, the more serious the disease is; if the quantification is ≥3.5g, nephrotic syndrome can be identified. In addition, the type of pathology and urine protein quantification are also important indicators to determine whether to use hormones. In this patient, for example, hormones can be used for IgA nephropathy with urine protein quantification ≥1g, while hormones are used only for microscopic lesion nephropathy with urine protein quantification ≥3.5g. Hypertension, proteinuria The two major factors that lead to the deterioration of kidney function in kidney disease, proteinuria even number one, the other more major factor is hypertension. In other words, if the high blood pressure and proteinuria of kidney patients cannot be controlled, it is difficult to avoid the deterioration of kidney function. Urine protein quantification Urine protein quantification is also the main indicator to determine the effect of nephritis treatment, for example, urine protein quantification <0.3g after treatment can be recognized as obvious improvement or cure. From the above facts, it is easy to find that hematuria is not taken seriously in the determination of the disease, whether to treat it or not, what drugs to use, and the evaluation of the efficacy. Since it was not taken seriously, it means that hematuria is less scary compared to proteinuria. That is why it is important not to take proteinuria lightly.