Causes of Proteinuria
List of causes of Proteinuria
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Proteinuria)
that could possibly cause Proteinuria includes:
More causes:
see full list of causes for Proteinuria
Causes of Proteinuria (Diseases Database):
The follow list shows some of the possible medical causes of Proteinuria
that are listed by the Diseases Database:
Source: Diseases Database
Proteinuria Causes: Book Excerpts
Proteinuria as a complication of other conditions:
Other conditions that might have
Proteinuria as a complication may,
potentially, be an underlying cause of Proteinuria.
Our database lists the following as having
Proteinuria as a complication of that condition:
Proteinuria as a symptom:
Conditions listing Proteinuria
as a symptom may also be potential underlying causes of Proteinuria.
Our database lists the following as having
Proteinuria as a symptom of that condition:
Medications or substances causing Proteinuria:
The following drugs, medications, substances or toxins are some of the possible
causes of Proteinuria as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
Read more about medication causes of Proteinuria
What causes Proteinuria?
Article excerpts about the
causes of Proteinuria:
Proteinuria: NIDDK (Excerpt)
As blood passes through healthy kidneys, they filter the waste products
out and leave in the things the body needs, like proteins. Most proteins
are too big to pass through the kidneys' filters into the urine, unless
the kidneys are damaged. The two proteins that are most likely to appear
in urine are albumin and globulin. Albumin is smaller and therefore more
likely to escape through the filters of the kidney, called glomeruli.
Albumin's function in the body includes retention of fluid in the blood.
It acts like a sponge, soaking up fluid from body tissues.
Inflammation in the glomeruli is called glomerulonephritis, or
simply nephritis. Many diseases can cause this inflammation, which
leads to proteinuria. Additional processes that can damage the glomeruli
and cause proteinuria include diabetes, hypertension, and other forms of
kidney diseases.
(Source: excerpt from Proteinuria: NIDDK)
Your Urinary System and How It Works: NIDDK (Excerpt)
In some cases, prostatitis is caused by bacterial infection and
can be treated with antibiotics. But the more common forms of prostatitis
are not associated with any known infecting organism. (Source: excerpt from Your Urinary System and How It Works: NIDDK)
Related information on causes of Proteinuria:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Proteinuria may be found in:
Causes of Proteinuria: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Proteinuria.
Hematuria:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Transient hematuria
–Urinary tract infection/pyelonephritis
–Nephrolithiasis (kidney or bladder stones)
–Exercise
–Trauma, instrumentation, catheterization, or foreign bodies
–Endometriosis
–Transient unexplained
–Henoch-Schönlein purpura/HUS
–Coagulopathy and excess anticoagulation
–Prostatitis, epididymitis
Persistent hematuria
–Sickle cell anemia
–Cancer (prostate, bladder, kidney)
–Benign prostatic hypertrophy
–Polycystic kidney disease
–Intrinsic glomerular disease Other causes of red or brown urine (pseudohematuria)
–Beeturia (14% population are susceptible after eating beets): Due to excretion of betalaine, a reddish pigment
–Myoglobinuria: Rapidly filtered and excreted; source is usually due to rhabdomyolysis; look for increased elevation of plasma CPK levels
–Hemoglobinuria: Occurs when the filtered load of unbound dimer exceeds resorptive capacity of the proximal tubules, generally at serum levels >100–150 mg/dL
Urethral carbuncle
Urethritis (e.g., Chlamydia)
Porphyria
Phenazopyridine (bladder analgesic): Produces an orange color in urine
Postinfectious glomerulonephropathy
Hereditary (Alport's syndrome)
IgA nephropathy (Berger's disease): Often see gross hematuria without positive family history of disease
Loin pain hematuria syndrome
Thin basement membrane disease (benign familial hematuria): Usually see microscopic hematuria; gross hematuria or renal failure is rare
Hypercalciuria or hyperuricuria
Arteriovenous malformation
Fistula
Others include food dyes, phenolphthalein, rifampin, and porphyrins
Excessive anticoagulation
Trauma
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Hematuria:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Transient (fever, dehydration, exercise)
-
Urinary tract infection
–Most common cause of gross hematuria
-
Hypercalciuria (common)
- Primary glomerulonephritis (GN)
–Acute poststreptococcal GN: Gross hematuria ±hypertension, oliguria; 5 days to several weeks after Group A strep pharyngitis or pyoderma; can also occur after other infections
–IgA nephropathy (Berger disease): recurrent gross hematuria occurs at or near onset of a URI
–Membranoproliferative GN
-
GN associated with systemic disease
–HSP
–SLE
–Other vasculitis (rare) e.g.,Wegener
-
Other glomerular disease
–Benign familial hematuria
–Alport syndrome: Usually X linked, high-
frequency deafness, progression to renal failure
–Glomerular disease (e.g., FSGS) usually presents as nephrotic syndrome
-
Tubulointerstitial disease
–Polycystic kidney disease, interstitial
nephritis, papillary necrosis, ATN
-
Urinary pelvic junction obstruction
-
Urolithiasis/nephrolithiasis
–Painless in up to 50% of children
-
Urethrorrhagia
–Recurrent gross hematuria (spotting on the
underwear)
–Most common in peripubertal males
-
Malignancies (e.g., Wilms tumor)
-
Vascular (e.g., renal vein thrombosis)
-
Trauma
-
Non-urinary tract blood
–Menses, perineal irritation, pinworms, masturbation, STDs, sexual abuse
-
Munchausen/Munchausen by proxy (rare)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Pyuria:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Urinary tract infection
-
Asymptomatic bacteriuria
–Relatively common in school-age girls
–Urine cultures are repeatedly positive
–Patients remain asymptomatic
-
Sexually transmitted disease (STD)
–Gonorrhea, Chlamydia, Trichomonas
–Bacterial vaginitis (can be nonsexually transmitted)
-
Other causes of vaginal discharge/perineal irritation (e.g., candidal vaginitis)
-
Acute interstitial nephritis
–“Allergic” tubulointerstitial process
–Occurs 7–14 days after exposure to inciting agent (e.g., antibiotics or NSAIDs)
–May have polyuria, fever, and rash, and elevated serum creatinine of unclear etiology
–Urinalysis is otherwise unremarkable
-
Inherited cystic diseases
–PKD: Occurs in both autosomal dominant and autosomal recessive forms
–Juvenile nephronophthisis: Rare cause of inherited chronic tubulointerstitial nephritis, steady progression to kidney failure in the first two decades of life, autosomal recessive inheritance
- Appendicitis
–May present with symptoms suggestive of acute pyelonephritis (fever, flank or abdominal pain)
–Urine culture is negative
–Symptoms are progressive
-
Renal tuberculosis
–Routine urine culture negative
-
Gastroenteritis (typically viral)
-
Lupus nephritis
-
Alport syndrome
-
Nail-patella syndrome
-
Urethritis
-
Kawasaki disease
–Most common vasculitis of childhood
–Characterized by high fever, irritability,
mucous membrane changes, edema of the hands and feet, lymphadenopathy
–Coronary vasculitis and aneurysms may result
–Treated with aspirin and IVIG
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Proteinuria:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Transient proteinuria
–With fever, dehydration, exercise, seizures, cold exposure, or stress
–Rarely >2+ on dipstick
–Usually remits within 1–2 weeks
-
Orthostatic (postural) proteinuria
–Occurs mostly in adolescence
–First morning U/A is negative for protein
- Primary glomerular disease
–MCNS: Most common cause of nephrotic syndrome (NS) in younger children, usually presents in ages 2–6, more common in boys; etiology possibly immune-mediated, typically responds to corticosteroids
–Mesangial proliferative GN: Intermediate lesion between MCNS and FSGS
–FSGS: Progressive disease of glomerular scarring, more common in blacks and adolescents, presents as NS or asymptomatic proteinuria, frequently resistant to corticosteroid therapy
–Membranous nephropathy
–Any primary GN (e.g., APSGN) can present with hematuria and proteinuria
-
Systemic lupus erythematosus nephritis
-
Henoch-Schönlein purpura (HSP)
-
Wegener granulomatosis
-
Tubulointerstitial disease: Proteinuria is less than with primary glomerular diseases
–Reflux nephropathy
–Renal dysplasia
–Interstitial nephritis (especially NSAIDs)
–Polycystic kidney disease
-
Infectious disease
–Bacterial (e.g., poststrep, shunt nephritis, leprosy, syphilis, infective endocarditis)
–Viral (e.g., HBV, CMV, EBV, VZV, HIV)
–Protozoal (e.g., malaria, toxoplasmosis)
–Parasitic (e.g., schistosomiasis, filariasis)
-
Neoplasm (e.g., lymphoma, leukemia, Wilms tumor, pheochromocytoma)
-
Alport syndrome
-
Fabry disease
-
Nail-patella syndrome
-
Medications (e.g. gold, mercurials)
-
Constrictive pericarditis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hematuria:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Bladder cancer
A primary cause of gross hematuria in men, bladder cancer may also produce pain in the bladder, rectum, pelvis, flank, back, or leg
Other common features are nocturia, dysuria, urinary frequency and urgency, vomiting, diarrhea, and insomnia.
Bladder trauma
Gross hematuria is characteristic in traumatic rupture or perforation of the bladder Typically, hematuria is accompanied by lower abdominal pain and, occasionally, anuria despite a strong urge to void
The patient may also develop swelling of the scrotum, buttocks, or perineum and signs of shock, such as tachycardia and hypotension.
Calculi
Bladder and renal calculi produce hematuria, which may be associated with signs of a urinary tract infection (UTI), such as dysuria and urinary frequency and urgency Bladder calculi usually cause gross hematuria, referred pain to the lower back or penile or vulvar area and, in some patients, bladder distention.
Renal calculi may produce microscopic or gross hematuria
The cardinal symptom, however, is colicky pain that travels from the CVA to the flank, suprapubic region, and external genitalia when a calculus is passed. The pain may be excruciating at its peak. Other signs and symptoms may include nausea and vomiting, restlessness, a fever, chills, abdominal distention and, possibly, decreased bowel sounds.
Coagulation disorders
Macroscopic hematuria is usually the first sign of hemorrhage in coagulation disorders, such as thrombocytopenia or disseminated intravascular coagulation
Other features include epistaxis, purpura (petechiae and ecchymoses), and signs of GI bleeding.
Cortical necrosis (acute)
Accompanying gross hematuria in acute cortical necrosis are intense flank pain, anuria, leukocytosis, and a fever.
Cystitis
Hematuria is a telling sign in all types of cystitis
Bacterial cystitis usually produces macroscopic hematuria with urinary urgency and frequency, dysuria, nocturia, and tenesmus. The patient complains of perineal and lumbar pain, suprapubic discomfort, and fatigue and occasionally has a low-grade fever.
More common in women, chronic interstitial cystitis occasionally causes grossly bloody hematuria. Associated features include urinary frequency, dysuria, nocturia, and tenesmus. Microscopic and macroscopic hematuria may occur with tubercular cystitis, which may also cause urinary urgency and frequency, dysuria, tenesmus, flank pain, fatigue, and anorexia. Viral cystitis usually produces hematuria, urinary urgency and frequency, dysuria, nocturia, tenesmus, and a fever.
Diverticulitis
When diverticulitis involves the bladder, it usually causes microscopic hematuria, urinary frequency and urgency, dysuria, and nocturia
Characteristic findings include left lower quadrant pain, abdominal tenderness, constipation or diarrhea and, at times, a palpable, firm, fixed, and tender abdominal mass The patient may also develop mild nausea, flatulence, and a low-grade fever.
Glomerulonephritis
Acute glomerulonephritis usually begins with gross hematuria that tapers off to microscopic hematuria and red cell casts, which may persist for months It may also produce oliguria or anuria, proteinuria, a mild fever, fatigue, flank and abdominal pain, generalized edema, increased blood pressure, nausea, vomiting, and signs of lung congestion, such as crackles and a productive cough.
Chronic glomerulonephritis usually causes microscopic hematuria accompanied by proteinuria, generalized edema, and increased blood pressure
Signs and symptoms of uremia may also occur in advanced disease.
Nephritis (interstitial)
Typically, nephritis causes microscopic hematuria However, the patient with acute interstitial nephritis may develop gross hematuria. Other findings are a fever, a maculopapular rash, and oliguria or anuria. In chronic interstitial nephritis, the patient has dilute — almost colorless — urine that may be accompanied by polyuria and increased blood pressure.
Nephropathy (obstructive)
Obstructive nephropathy may cause microscopic or macroscopic hematuria, but urine is rarely grossly bloody The patient may report colicky flank and abdominal pain, CVA tenderness, and anuria or oliguria that alternates with polyuria.
Polycystic kidney disease
Polycystic kidney disease is a hereditary disorder that may cause recurrent microscopic or gross hematuria
Although commonly asymptomatic before age 40, it may cause increased blood pressure, polyuria, dull flank pain, and signs of a UTI, such as dysuria and urinary frequency and urgency Later, the patient develops a swollen, tender abdomen and lumbar pain that’s aggravated by exertion and relieved by lying down
He may also have proteinuria and colicky abdominal pain from the ureteral passage of clots or stones.
Prostatitis
Whether acute or chronic, prostatitis may cause macroscopic hematuria, usually at the end of urination It may also produce urinary frequency and urgency and dysuria followed by visible bladder distention.
Acute prostatitis also produces fatigue, malaise, myalgia, polyarthralgia, a fever with chills, nausea, vomiting, perineal and low back pain, and a decreased libido
Rectal palpation reveals a tender, swollen, boggy, firm prostate.
Chronic prostatitis commonly follows an acute attack. It may cause persistent urethral discharge, dull perineal pain, ejaculatory pain, and a decreased libido.
Pyelonephritis (acute)
Acute pyelonephritis typically produces microscopic or macroscopic hematuria that progresses to grossly bloody hematuria
After the infection resolves, microscopic hematuria may persist for a few months. Related signs and symptoms include a persistent high fever, unilateral or bilateral flank pain, CVA tenderness, shaking chills, weakness, fatigue, dysuria, urinary frequency and urgency, nocturia, and tenesmus. The patient may also exhibit nausea, anorexia, vomiting, and signs of paralytic ileus, such as hypoactive or absent bowel sounds and abdominal distention.
Renal cancer
The classic triad of signs and symptoms includes grossly bloody hematuria; dull, aching flank pain; and a smooth, firm, palpable flank mass
Colicky pain may accompany the passage of clots Other findings include a fever, CVA tenderness, and increased blood pressure
In advanced disease, the patient may develop weight loss, nausea and vomiting, and leg edema with varicoceles.
Renal infarction
Typically, renal infarction produces gross hematuria The patient may complain of constant, severe flank and upper abdominal pain accompanied by CVA tenderness, anorexia, and nausea and vomiting
Other findings include oliguria or anuria, proteinuria, hypoactive bowel sounds and, a day or two after infarction, a fever and increased blood pressure.
Renal papillary necrosis (acute)
Acute renal papillary necrosis usually produces grossly bloody hematuria, which may be accompanied by intense flank pain, CVA tenderness, abdominal rigidity and colicky pain, oliguria or anuria, pyuria, fever, chills, vomiting, and hypoactive bowel sounds Arthralgia and hypertension are common.
Renal trauma
About 80% of patients with renal trauma have microscopic or gross hematuria Accompanying signs and symptoms may include flank pain, a palpable flank mass, oliguria, hematoma or ecchymoses over the upper abdomen or flank, nausea and vomiting, and hypoactive bowel sounds
Severe trauma may precipitate signs of shock, such as tachycardia and hypotension.
Renal tuberculosis
Gross hematuria is commonly the first sign of renal tuberculosis It may be accompanied by urinary frequency, dysuria, pyuria, tenesmus, colicky abdominal pain, lumbar pain, and proteinuria.
Renal vein thrombosis
Grossly bloody hematuria usually occurs in renal vein thrombosis In abrupt venous obstruction, the patient experiences severe flank and lumbar pain as well as epigastric and CVA tenderness
Other features include a fever, pallor, proteinuria, peripheral edema and, when the obstruction is bilateral, oliguria or anuria and other uremic signs. The kidneys are easily palpable. Gradual venous obstruction causes signs of nephrotic syndrome, proteinuria and, occasionally, peripheral edema.
Schistosomiasis
Schistosomiasis usually causes intermittent hematuria at the end of urination It may be accompanied by dysuria, colicky renal and bladder pain, and palpable lower abdominal masses.
Sickle cell anemia
Sickle cell anemia is a hereditary disorder in which gross hematuria may result from congestion of the renal papillae Associated signs and symptoms may include pallor, dehydration, chronic fatigue, polyarthralgia, leg ulcers, dyspnea, chest pain, impaired growth and development, hepatomegaly and, possibly, jaundice
Auscultation reveals tachycardia and systolic and diastolic murmurs.
Systemic lupus erythematosus (SLE)
Gross hematuria and proteinuria may occur when SLE involves the kidneys Cardinal associated features include nondeforming joint pain and stiffness, a butterfly rash, photosensitivity, Raynaud’s phenomenon, seizures or psychoses, a recurrent fever, lymphadenopathy, oral or nasopharyngeal ulcers, anorexia, and weight loss.
Urethral trauma
Initial hematuria may occur, possibly with blood at the urinary meatus, local pain, and penile or vulvar ecchymoses.
Vasculitis
Hematuria is usually microscopic in vasculitis Associated signs and symptoms include malaise, myalgia, polyarthralgia, a fever, increased blood pressure, pallor and, occasionally, anuria
Other features, such as urticaria and purpura, may reflect the etiology of vasculitis.
Other causes
Diagnostic tests
Renal biopsy is the diagnostic test most commonly associated with hematuria This sign may also result from biopsy or manipulative instrumentation of the urinary tract such as in cystoscopy.
Drugs
Drugs that commonly cause hematuria are anticoagulants, aspirin (toxicity), analgesics, cyclophosphamide, metyrosine, phenylbutazone, oxyphenbutazone, penicillin, rifampin, and thiabendazole.
Herb alert
When taken with an anticoagulant, herbal remedies, such as garlic and ginkgo biloba, can cause adverse reactions, including excessive bleeding and hematuria.
Treatments
Any therapy that involves manipulative instrumentation of the urinary tract, such as transurethral prostatectomy, may cause microscopic or macroscopic hematuria Following a kidney transplant, a patient may experience hematuria with or without clots, which may require indwelling urinary catheter irrigation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Urine cloudiness:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Urinary tract infection (UTI)
Cloudy urine is common with UTI. Other urinary changes include urgency, frequency, hematuria, dysuria, nocturia and, in males, urethral discharge. Urinary hesitancy; bladder spasms; costovertebral angle tenderness; and suprapubic, lower back, or flank pain may occur. Other effects include fever, chills, malaise, nausea, and vomiting.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hematuria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Appendicitis
About 15% of patients with appendicitis have either microscopic or macroscopic hematuria accompanied by bladder tenderness, dysuria, and urinary urgency. More typical findings include constant right-lower-quadrant pain (especially over McBurney’s point), nausea and vomiting, anorexia, abdominal rigidity, rebound tenderness, constipation, tachycardia, and low-grade fever.
Bladder cancer
A primary cause of gross hematuria in men, bladder cancer may also produce pain in the bladder, rectum, pelvis, flank, back, or leg. Other common features are nocturia, dysuria, urinary frequency and urgency, vomiting, diarrhea, and insomnia.
Bladder trauma
A characteristic finding in traumatic rupture or perforation of the bladder, gross hematuria is typically accompanied by lower abdominal pain. The patient may also develop anuria despite a strong urge to void; swelling of the scrotum, buttocks, or perineum; and signs of shock, such as tachycardia and hypotension.
Calculi
Both bladder and renal calculi produce hematuria, which may be associated with signs of urinary tract infection, such as dysuria and urinary frequency and urgency. Bladder calculi may also cause gross hematuria, referred pain to the lower back or penile or vulvar area and, occasionally, bladder distention.
Renal calculi may produce microscopic or gross hematuria. The cardinal symptom, though, is colicky pain that travels from the CVA to the flank, suprapubic region, and external genitalia when a calculus is passed. The pain may be excruciating at its peak. Other signs and symptoms may include nausea and vomiting, restlessness, fever, chills, abdominal distention and, possibly, decreased bowel sounds.
Coagulation disorders
Macroscopic hematuria is commonly the first sign of hemorrhage in coagulation disorders, such as thrombocytopenia or disseminated intravascular coagulation. Among other features are epistaxis, purpura (petechiae and ecchymosis), and signs of GI bleeding.
Cortical necrosis (acute)
Accompanying gross hematuria in this renal disorder are intense flank pain, anuria, leukocytosis, and fever.
Cystitis
Hematuria is a telling sign in all types of cystitis. Bacterial cystitis usually produces macroscopic hematuria with urinary urgency and frequency, dysuria, nocturia, and tenesmus. The patient complains of perineal and lumbar pain, suprapubic discomfort, and fatigue and occasionally has a low-grade fever.
More common in women, chronic interstitial cystitis occasionally causes gross hematuria. Associated features include urinary frequency, dysuria, nocturia, and tenesmus. Both microscopic and macroscopic hematuria may occur in tubercular cystitis, which may also cause urinary urgency and frequency, dysuria, tenesmus, flank pain, fatigue, and anorexia. Viral cystitis usually produces hematuria, urinary urgency and frequency, dysuria, nocturia, tenesmus, and fever.
Diverticulitis
When this disorder involves the bladder, it usually causes microscopic hematuria, urinary frequency and urgency, dysuria, and nocturia. Characteristic findings include left-lower-quadrant pain, abdominal tenderness, constipation or diarrhea and, occasionally, a palpable, firm, fixed, and tender abdominal mass. The patient may also develop mild nausea, flatulence, and a low-grade fever.
Endocarditis (subacute infective)
Occasionally, this disorder produces embolization, resulting in renal infarction and microscopic or gross hematuria. Common related findings are constant fever, chills, night sweats, fatigue, pallor, anorexia, weight loss, polyarthralgia, petechiae, flank pain, severe back pain, stiff neck, cardiac murmurs, tachycardia, and splenomegaly.
Glomerulonephritis
Acute glomerulonephritis usually begins with gross hematuria that tapers off to microscopic hematuria and RBC casts, which may persist for months. It may also produce oliguria or anuria, proteinuria, mild fever, fatigue, flank and abdominal pain, generalized edema, increased blood pressure, nausea, vomiting, and signs of lung congestion, such as crackles and a productive cough.
Chronic glomerulonephritis usually causes microscopic hematuria accompanied by proteinuria, generalized edema, and increased blood pressure. Signs and symptoms of uremia may also occur in advanced disease.
Nephritis (interstitial)
Typically, this infection causes microscopic hematuria. However, some patients with acute interstitial nephritis may develop gross hematuria. Other findings are fever, maculopapular rash, and oliguria or anuria. In chronic interstitial nephritis, the patient has dilute—almost colorless—urine that may be accompanied by polyuria and increased blood pressure.
Nephropathy (obstructive)
This disorder may cause microscopic or macroscopic hematuria, but urine is rarely grossly bloody. The patient may report colicky flank and abdominal pain, CVA tenderness, and anuria or oliguria that alternates with polyuria.
Polycystic kidney disease
This hereditary disorder may cause recurrent microscopic or gross hematuria. It commonly produces no symptoms before age 40 but may cause increased blood pressure, polyuria, dull flank pain, and signs of urinary tract infection, such as dysuria and urinary frequency and urgency. Later, the patient develops a swollen, tender abdomen and lumbar pain that’s aggravated by exertion and relieved by lying down. He may also have proteinuria and colicky abdominal pain from the ureteral passage of clots or calculi.
Prostatic hyperplasia (benign)
About 20% of patients with an enlarged prostate have macroscopic hematuria, usually when a significant obstruction is present. The hematuria is usually preceded by diminished urinary stream, tenesmus, and a feeling of incomplete voiding. It may be accompanied by urinary hesitancy, frequency, and incontinence; nocturia; perineal pain; and constipation. Inspection reveals a midline mass representing the distended bladder; rectal palpation reveals an enlarged prostate.
Prostatitis
Whether acute or chronic, prostatitis may cause macroscopic hematuria, usually at the end of urination. It may also produce urinary frequency and urgency and dysuria followed by visible bladder distention.
Acute prostatitis also produces fatigue, malaise, myalgia, polyarthralgia, fever with chills, nausea, vomiting, perineal and low back pain, and decreased libido. Rectal palpation reveals a tender, swollen, boggy, firm prostate.
Chronic prostatitis commonly follows an acute attack. It may cause persistent urethral discharge, dull perineal pain, ejaculatory pain, and decreased libido.
Pyelonephritis (acute)
This infection typically produces microscopic or macroscopic hematuria that progresses to gross hematuria. After the infection resolves, microscopic hematuria may persist for a few months. Related signs and symptoms include persistent high fever, unilateral or bilateral flank pain, CVA tenderness, shaking chills, weakness, fatigue, dysuria, urinary frequency and urgency, nocturia, and tenesmus. The patient may also exhibit nausea, vomiting, anorexia, and signs of paralytic ileus, such as hypoactive or absent bowel sounds and abdominal distention.
Renal cancer
The classic triad of signs and symptoms includes gross hematuria; dull, aching flank pain; and a smooth, firm, palpable flank mass. Colicky pain may accompany the passage of clots. Other findings include fever, CVA tenderness, and increased blood pressure. In advanced disease, the patient may develop weight loss, nausea and vomiting, and leg edema with varicoceles.
Renal infarction
Typically, this disorder produces gross hematuria. The patient may complain of constant, severe flank and upper abdominal pain accompanied by CVA tenderness, anorexia, and nausea and vomiting. Other findings include oliguria or anuria, proteinuria, hypoactive bowel sounds and, a day or two after the infarction, fever and increased blood pressure.
Renal papillary necrosis (acute)
This disorder usually produces gross hematuria, which may be accompanied by intense flank pain, CVA tenderness, abdominal rigidity and colicky pain, oliguria or anuria, pyuria, fever, chills, vomiting, and hypoactive bowel sounds. Arthralgia and hypertension are common.
Renal trauma
About 80% of patients with renal trauma have microscopic or gross hematuria. Accompanying signs and symptoms may include flank pain, a palpable flank mass, oliguria, hematoma or ecchymosis over the upper abdomen or flank, nausea and vomiting, and hypoactive bowel sounds. Severe trauma may precipitate signs of shock, such as tachycardia and hypotension.
Renal tuberculosis
Gross hematuria is often the first sign of this disorder. It may be accompanied by urinary frequency, dysuria, pyuria, tenesmus, colicky abdominal pain, lumbar pain, and proteinuria.
Renal vein thrombosis
Gross hematuria usually occurs in this type of thrombosis. In an abrupt venous obstruction, the patient experiences severe flank and lumbar pain as well as epigastric and CVA tenderness. Other features include fever, pallor, proteinuria, peripheral edema and, when the obstruction is bilateral, oliguria or anuria and other uremic signs. The kidneys are easily palpable. Gradual venous obstruction causes signs of nephrotic syndrome, proteinuria and, occasionally, peripheral edema.
Schistosomiasis
This infection usually causes intermittent hematuria at the end of urination. It may be accompanied by dysuria, colicky renal and bladder pain, and palpable lower abdominal masses.
Sickle cell anemia
In this hereditary disorder, gross hematuria may result from congestion of the renal papillae. Associated signs and symptoms may include pallor, dehydration, chronic fatigue, polyarthralgia, leg ulcers, dyspnea, chest pain, impaired growth and development, hepatomegaly and, possibly, jaundice. Auscultation reveals tachycardia and systolic and diastolic murmurs.
Systemic lupus erythematosus
Gross hematuria and proteinuria may occur when this disorder involves the kidneys. Cardinal features include nondeforming joint pain and stiffness, a butterfly rash, photosensitivity, Raynaud’s phenomenon, seizures or psychoses, recurrent fever, lymphadenopathy, oral or nasopharyngeal ulcers, anorexia, and weight loss.
Urethral trauma
Hematuria may occur initially, possibly with blood at the urinary meatus, local pain, and penile or vulvar ecchymosis.
Vaginitis
When this infection spreads to the urinary tract, it may produce macroscopic hematuria. Related signs and symptoms may include urinary frequency and urgency, dysuria, nocturia, perineal pain, pruritus, and a malodorous vaginal discharge.
Vasculitis
Hematuria is usually microscopic in this disorder. Associated signs and symptoms include malaise, myalgia, polyarthralgia, fever, increased blood pressure, pallor and, occasionally, anuria. Other features, such as urticaria and purpura, may reflect the etiology of vasculitis.
Other causes
Diagnostic tests
Renal biopsy is the diagnostic test most often associated with hematuria. This sign may also result from biopsy or manipulative instrumentation of the urinary tract, as in cystoscopy.
Drugs
Drugs that commonly cause hematuria are anticoagulants, aspirin (toxicity), analgesics, cyclophosphamide, metyrosine, penicillin, rifampin, and thiabendazole.
Herb Alert
When taken with an anticoagulant, herbal medicines such as garlic and ginkgo biloba can cause excessive bleeding and hematuria.
Treatments
Any therapy that involves manipulative instrumentation of the urinary tract, such as transurethral prostatectomy, may cause microscopic or macroscopic hematuria. After a kidney transplant, a patient may experience hematuria with or without clots, which may require indwelling urinary catheter irrigation.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urine cloudiness:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
UTI
Cloudy urine is common in UTIs. Other urinary findings include urgency, frequency, hesitancy, hematuria, dysuria, nocturia and, in males, a urethral discharge. Other effects include fever, chills, malaise, nausea and vomiting, bladder spasms, costovertebral angle tenderness, and suprapubic, low back, or flank pain.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hematuria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Urinary tract infection
❑ Nephrolithiasis
❑ Anticoagulation
❑ Long distance running
❑ Renal trauma
❑ Bladder cancer
❑ Renal cell cancer
❑ Transitional cell cancer
❑ Glomerulonephritis
❑ Interstitial cystitis
❑ Hemorrhagic cystitis
❑ Hemoglobinuria
❑ Endocarditis
❑ Polycystic kidney disease
❑ Renal artery embolism
❑ Renal vein thrombosis
❑ Endometrial implants
❑ Wegener granulomatosis
❑ Goodpasture syndrome
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Proteinuria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Diabetes
❑ Drugs/toxins
❑ Acute tubular necrosis
❑ Glomerulonephritis
❑ Orthostatic
❑ Systemic lupus erythematosus
❑ Toxemia
❑ Polycystic kidneys
❑ Interstitial nephritis
❑ Renal vein thrombosis
❑ Multiple myeloma
❑ Amyloidosis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Hematuria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Appendicitis
About 15% of patients with appendicitis have either microscopic or macroscopic hematuria accompanied by bladder tenderness, dysuria, and urinary urgency. More typical findings include constant right-lower-quadrant pain (especially over McBurney’s point), nausea and vomiting, anorexia, abdominal rigidity, rebound tenderness, constipation, tachycardia, and low-grade fever.
Bladder cancer
A primary cause of gross hematuria in men, bladder cancer may also produce pain in the bladder, rectum, pelvis, flank, back, or leg. Other common features are nocturia, dysuria, urinary frequency and urgency, vomiting, diarrhea, and insomnia.
Bladder trauma
Gross hematuria is characteristic in traumatic rupture or perforation of the bladder. Typically, the hematuria is accompanied by lower abdominal pain and, occasionally, anuria despite a strong urge to void. The patient may also develop swelling of the scrotum, buttocks, or perineum and signs of shock, such as tachycardia and hypotension.
Calculi
Bladder and renal calculi produce hematuria, which may be associated with signs of urinary tract infection, such as dysuria and urinary frequency and urgency. Bladder calculi usually cause gross hematuria, referred pain to the lower back or penile or vulvar area and, in some patients, bladder distention.
Renal calculi may produce microscopic or gross hematuria. The cardinal symptom, though, is colicky pain that travels from the CVA to the flank, suprapubic region, and external genitalia when a calculus is passed. The pain may be excruciating at its peak. Other signs and symptoms may include nausea and vomiting, restlessness, fever, chills, abdominal distention and, possibly, decreased bowel sounds.
Coagulation disorders
Macroscopic hematuria is typically the first sign of hemorrhage in coagulation disorders, such as thrombocytopenia or disseminated intravascular coagulation. Among other features are epistaxis, purpura (petechiae and ecchymoses), and signs of GI bleeding.
Cystitis
Hematuria is a telling sign in all types of cystitis. Bacterial cystitis usually produces macroscopic hematuria with urinary urgency and frequency, dysuria, nocturia, and tenesmus. The patient complains of perineal and lumbar pain, suprapubic discomfort, and fatigue and occasionally has a low-grade fever.
More common in women, chronic interstitial cystitis occasionally causes grossly bloody hematuria. Associated features include urinary frequency, dysuria, nocturia, and tenesmus. Both microscopic and macroscopic hematuria may occur with tubercular cystitis, which may also cause urinary urgency and frequency, dysuria, tenesmus, flank pain, fatigue, and anorexia. Viral cystitis usually produces hematuria, urinary urgency and frequency, dysuria, nocturia, tenesmus, and fever.
Diverticulitis
When diverticulitis involves the bladder, it usually causes microscopic hematuria, urinary frequency and urgency, dysuria, and nocturia. Characteristic findings include left-lower-quadrant pain, abdominal tenderness, constipation or diarrhea and, at times, a palpable, firm, fixed, and tender abdominal mass. The patient may also develop mild nausea, flatulence, and a low-grade fever.
Endocarditis (subacute infective)
Occasionally, subacute infective endocarditis produces embolization, resulting in renal infarction and microscopic or gross hematuria. Among common related findings are constant fever, chills, night sweats, fatigue, pallor, anorexia, weight loss, polyarthralgia, petechiae, flank pain, severe back pain, stiff neck, cardiac murmurs, tachycardia, and splenomegaly.
Glomerulonephritis
Acute glomerulonephritis usually begins with gross hematuria that tapers off to microscopic hematuria and red cell casts, which may persist for months. It may also produce oliguria or anuria, proteinuria, mild fever, fatigue, flank and abdominal pain, generalized edema, increased blood pressure, nausea, vomiting, and signs of lung congestion, such as crackles and a productive cough.
Chronic glomerulonephritis usually causes microscopic hematuria accompanied by proteinuria, generalized edema, and increased blood pressure. Signs and symptoms of uremia may also occur in advanced disease.
Nephritis (interstitial)
Typically, this infection causes microscopic hematuria. However, some patients with acute interstitial nephritis may develop gross hematuria. Other findings are fever, maculopapular rash, and oliguria or anuria. In chronic interstitial nephritis, the patient has dilute — almost colorless — urine that may be accompanied by polyuria and increased blood pressure.
Nephropathy (obstructive)
Obstructive nephropathy may cause microscopic or macroscopic hematuria, but rarely is urine grossly bloody. The patient may report colicky flank and abdominal pain, CVA tenderness, and anuria or oliguria that alternates with polyuria.
Polycystic kidney disease
Polycystic kidney disease, a hereditary disorder, may cause recurrent microscopic or gross hematuria. Although usually asymptomatic before age 40, it may cause increased blood pressure, polyuria, dull flank pain, and signs of urinary tract infection, such as dysuria and urinary frequency and urgency. Later, the patient develops a swollen, tender abdomen and lumbar pain that’s aggravated by exertion and relieved by lying down. He may also have proteinuria and colicky abdominal pain from the ureteral passage of clots or stones.
Prostatic hyperplasia (benign)
About 20% of patients with enlarged prostates have macroscopic hematuria, usually when a significant obstruction is present. The hematuria is usually preceded by diminished urinary stream, tenesmus, and a feeling of incomplete voiding. It may be accompanied by urinary hesitancy, frequency, and incontinence; nocturia; perineal pain; and constipation. Inspection reveals a midline mass representing the distended bladder; rectal palpation reveals an enlarged prostate.
Prostatitis
Whether acute or chronic, prostatitis may cause macroscopic hematuria, usually at the end of urination. It may also produce urinary frequency and urgency and dysuria followed by visible bladder distention.
Acute prostatitis also produces fatigue, malaise, myalgia, polyarthralgia, fever with chills, nausea, vomiting, perineal and low back pain, and decreased libido. Rectal palpation reveals a tender, swollen, firm prostate.
Chronic prostatitis commonly follows an acute attack. It may cause persistent urethral discharge, dull perineal pain, ejaculatory pain, and decreased libido.
Pyelonephritis (acute)
Acute pyelonephritis typically produces microscopic or macroscopic hematuria that progresses to grossly bloody hematuria. After the infection resolves, microscopic hematuria may persist for a few months. Related signs and symptoms include persistent high fever, unilateral or bilateral flank pain, CVA tenderness, shaking chills, weakness, fatigue, dysuria, urinary frequency and urgency, nocturia, and tenesmus. The patient may also exhibit nausea, anorexia, vomiting, and signs of paralytic ileus, such as hypoactive or absent bowel sounds and abdominal distention.
Renal cancer
The classic triad of signs and symptoms of renal cancer includes grossly bloody hematuria; dull, aching flank pain; and a smooth, firm, palpable flank mass. Colicky pain may accompany the passage of clots. Other findings include fever, CVA tenderness, and increased blood pressure. In advanced disease, the patient may develop weight loss, nausea and vomiting, and leg edema with varicoceles.
Renal infarction
Typically, this disorder produces gross hematuria. The patient may complain of constant, severe flank and upper abdominal pain accompanied by CVA tenderness, anorexia, and nausea and vomiting. Other findings include oliguria or anuria, proteinuria, hypoactive bowel sounds and, a day or two after infarction, fever and increased blood pressure.
Renal papillary necrosis (acute)
Acute renal papillary necrosis usually produces grossly bloody hematuria, which may be accompanied by intense flank pain, CVA tenderness, abdominal rigidity and colicky pain, oliguria or anuria, pyuria, fever, chills, vomiting, and hypoactive bowel sounds. Arthralgia and hypertension are common.
Renal trauma
About 80% of patients with renal trauma have microscopic or gross hematuria. Accompanying signs and symptoms may include flank pain, a palpable flank mass, oliguria, hematoma or ecchymoses over the upper abdomen or flank, nausea and vomiting, and hypoactive bowel sounds. Severe trauma may precipitate signs of shock, such as tachycardia and hypotension.
Renal tuberculosis
Gross hematuria is often the first sign of renal tuberculosis. It may be accompanied by urinary frequency, dysuria, pyuria, tenesmus, colicky abdominal pain, lumbar pain, and proteinuria.
Renal vein thrombosis
Grossly bloody hematuria usually occurs in renal vein thrombosis. In abrupt venous obstruction, the patient experiences severe flank and lumbar pain as well as epigastric and CVA tenderness. Other features include fever, pallor, proteinuria, peripheral edema and, when the obstruction is bilateral, oliguria or anuria and other uremic signs. The kidneys are easily palpable. Gradual venous obstruction causes signs of nephrotic syndrome, proteinuria and, occasionally, peripheral edema.
Sickle cell anemia
In this hereditary disorder, gross hematuria may result from congestion of the renal papillae. Associated signs and symptoms of sickle cell anemia may include pallor, dehydration, chronic fatigue, polyarthralgia, leg ulcers, dyspnea, chest pain, impaired growth and development, hepatomegaly and, possibly, jaundice. Auscultation reveals tachycardia and systolic and diastolic murmurs.
Systemic lupus erythematosus
Gross hematuria and proteinuria may occur when systemic lupus erythematosus (SLE) involves the kidneys. Cardinal associated features include nondeforming joint pain and stiffness, a butterfly rash, photosensitivity, Raynaud’s phenomenon, seizures or psychoses, recurrent fever, lymphadenopathy, oral or nasopharyngeal ulcers, anorexia, and weight loss.
Urethral trauma
With urethral trauma, initial hematuria may occur, possibly with blood at the urinary meatus, local pain, and penile or vulvar ecchymoses.
Vaginitis
When vaginitis spreads to the urinary tract, it may produce macroscopic hematuria. Related signs and symptoms may include urinary frequency and urgency, dysuria, nocturia, perineal pain, pruritus, and a malodorous vaginal discharge.
Vasculitis
Hematuria is usually microscopic in vasculitis. Associated signs and symptoms include malaise, myalgia, polyarthralgia, fever, increased blood pressure, pallor and, occasionally, anuria. Other features, such as urticaria and purpura, may reflect the etiology of vasculitis.
Other causes
Diagnostic tests
Renal biopsy is the diagnostic test most often associated with hematuria. This sign may also result from biopsy or manipulative instrumentation of the urinary tract, as in cystoscopy.
Drugs
Drugs that commonly cause hematuria are anticoagulants, aspirin toxicity, analgesics, cyclophosphamide, metyrosine, phenylbutazone, penicillin, rifampin, and thiabendazole.
Treatments
Any therapy that involves manipulative instrumentation of the urinary tract, such as transurethral prostatectomy, may cause microscopic or macroscopic hematuria. Following a kidney transplant a patient may experience hematuria with or without clots, which may require indwelling urinary catheter irrigation.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hematuria:
Principal Causes of Hematuria
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Hematuriawithout proteinuria
- Glomerular disorders
- Acute postinfectious glomerulonephritis
- Immunoglobulin A nephropathy
- Henoch-Schönlein nephritis
- Alport syndrome
- Membranoproliferative glomerulonephritis
- Systemic lupus erythematosus
- Familial benign hematuria (thin basementmembrane nephropathy)
- Nonfamilial benign hematuria
- Nonglomerular disorders
- Urinarytract infection
- Trauma
- Exercise
- Hydronephrosis
- Renal vein thrombosis
- Hemoglobinopathies
- Idiopathic hypercalciuria
- Urolithiasis
- Polycystic kidney disease
- Renal tuberculosis
- Vascular malformations
- Foreign body in the urethra or bladder
- Neoplasm
- Bleeding disorders
- Drugs
- Hematuria with proteinuria
- Glomerulardisorders
- Acutepostinfectious glomerulonephritis
- Immunoglobulin A nephropathy
- Henoch-Schönlein nephritis
- Alport syndrome
- Membranoproliferative glomerulonephritis
- Systemic lupus erythematosus
- Membranous nephropathy
- Glomerulonephritis of chronic infection
- Idiopathic rapidly progressive glomerulonephritis
- Hemolytic-uremic syndrome
- Polyarteritis nodosa
- Antiglomerular basement membrane disease(Goodpasture disease)
- Focal segmental glomerulosclerosis
- Wegener granulomatosis
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Proteinuria:
Principal Causes of Proteinuria
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Functional/transientproteinuria
- Fever
- Strenuous exercise
- Extreme cold
- Cardiac failure
- Seizures
- Emotional stress
- Postural proteinuria (orthostatic)
- Nephrotic syndrome
- Tubulointerstitial disease
- Refluxnephropathy
- Tubulointerstitial nephritis
- Fanconi syndrome
- Ischemic tubular injury
- Benign persistent proteinuria
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hematuria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Bladder cancer.A primary cause of gross hematuria in men, bladder cancer may also produce pain in the bladder, rectum, pelvis, flank, back, or leg. Other common features are nocturia, dysuria, urinary frequency and urgency, vomiting, diarrhea, and insomnia.
Bladder trauma.Gross hematuria is characteristic in traumatic rupture or perforation of the bladder. Typically, hematuria is accompanied by lower abdominal pain and, occasionally, anuria despite a strong urge to void. The patient may also develop swelling of the scrotum, buttocks, or perineum and signs of shock, such as tachycardia and hypotension.
Calculi.Bladder and renal calculi produce hematuria, which may be associated with signs of a urinary tract infection (UTI), such as dysuria and urinary frequency and urgency. Bladder calculi usually cause gross hematuria, referred pain to the lower back or penile or vulvar area and, in some patients, bladder distention.
Renal calculi may produce microscopic or gross hematuria. The cardinal symptom, however, is colicky pain that travels from the CVA to the flank, suprapubic region, and external genitalia when a calculus is passed. The pain may be excruciating at its peak. Other signs and symptoms may include nausea and vomiting, restlessness, a fever, chills, abdominal distention and, possibly, decreased bowel sounds.
Coagulation disorders.Macroscopic hematuria is usually the first sign of hemorrhage in coagulation disorders, such as thrombocytopenia or disseminated intravascular coagulation. Other features include epistaxis, purpura (petechiae and ecchymoses), and signs of GI bleeding.
Cortical necrosis (acute).Accompanying gross hematuria in acute cortical necrosis are intense flank pain, anuria, leukocytosis, and a fever.
Cystitis.Hematuria is a telling sign in all types of cystitis. Bacterial cystitis usually produces macroscopic hematuria with urinary urgency and frequency, dysuria, nocturia, and tenesmus. The patient complains of perineal and lumbar pain, suprapubic discomfort, and fatigue and occasionally has a low-grade fever.
More common in women, chronic interstitial cystitis occasionally causes grossly bloody hematuria. Associated features include urinary frequency, dysuria, nocturia, and tenesmus. Microscopic and macroscopic hematuria may occur with tubercular cystitis, which may also cause urinary urgency and frequency, dysuria, tenesmus, flank pain, fatigue, and anorexia. Viral cystitis usually produces hematuria, urinary urgency and frequency, dysuria, nocturia, tenesmus, and a fever.
Diverticulitis.When diverticulitis involves the bladder, it usually causes microscopic hematuria, urinary frequency and urgency, dysuria, and nocturia. Characteristic findings include left lower quadrant pain, abdominal tenderness, constipation or diarrhea and, at times, a palpable, firm, fixed, and tender abdominal mass. The patient may also develop mild nausea, flatulence, and a low-grade fever.
Glomerulonephritis.Acute glomerulonephritis usually begins with gross hematuria that tapers off to microscopic hematuria and red cell casts, which may persist for months. It may also produce oliguria or anuria, proteinuria, a mild fever, fatigue, flank and abdominal pain, generalized edema, increased blood pressure, nausea, vomiting, and signs of lung congestion, such as crackles and a productive cough.
Chronic glomerulonephritis usually causes microscopic hematuria accompanied by proteinuria, generalized edema, and increased blood pressure. Signs and symptoms of uremia may also occur in advanced disease.
Nephritis (interstitial).Typically, nephritis causes microscopic hematuria. However, the patient with acute interstitial nephritis may develop gross hematuria. Other findings are a fever, a maculopapular rash, and oliguria or anuria. In chronic interstitial nephritis, the patient has dilute—almost colorless—urine that may be accompanied by polyuria and increased blood pressure.
Nephropathy (obstructive).Obstructive nephropathy may cause microscopic or macroscopic hematuria, but urine is rarely grossly bloody. The patient may report colicky flank and abdominal pain, CVA tenderness, and anuria or oliguria that alternates with polyuria.
Polycystic kidney disease.Polycystic kidney disease is a hereditary disorder that may cause recurrent microscopic or gross hematuria. Although it commonly produces no symptoms before age 40, it may cause increased blood pressure, polyuria, dull flank pain, and signs of a UTI, such as dysuria and urinary frequency and urgency. Later, the patient develops a swollen, tender abdomen and lumbar pain that's aggravated by exertion and relieved by lying down. He may also have proteinuria and colicky abdominal pain from the ureteral passage of clots or calculi.
Prostatitis.Whether acute or chronic, prostatitis may cause macroscopic hematuria, usually at the end of urination. It may also produce urinary frequency and urgency and dysuria followed by visible bladder distention.
Acute prostatitis also produces fatigue, malaise, myalgia, polyarthralgia, a fever with chills, nausea, vomiting, perineal and low back pain, and a decreased libido. Rectal palpation reveals a tender, swollen, boggy, firm prostate.
Chronic prostatitis commonly follows an acute attack. It may cause persistent urethral discharge, dull perineal pain, ejaculatory pain, and a decreased libido.
Pyelonephritis (acute).Acute pyelonephritis typically produces microscopic or macroscopic hematuria that progresses to grossly bloody hematuria. After the infection resolves, microscopic hematuria may persist for a few months. Related signs and symptoms include a persistent high fever, unilateral or bilateral flank pain, CVA tenderness, shaking chills, weakness, fatigue, dysuria, urinary frequency and urgency, nocturia, and tenesmus. The patient may also exhibit nausea, anorexia, vomiting, and signs of paralytic ileus, such as hypoactive or absent bowel sounds and abdominal distention.
Renal cancer.The classic triad of signs and symptoms of renal cancer includes grossly bloody hematuria; dull, aching flank pain; and a smooth, firm, palpable flank mass. Colicky pain may accompany the passage of clots. Other findings include a fever, CVA tenderness, and increased blood pressure. In advanced disease, the patient may develop weight loss, nausea and vomiting, and leg edema with varicoceles.
Renal infarction.Typically, renal infarction produces gross hematuria. The patient may complain of constant, severe flank and upper abdominal pain accompanied by CVA tenderness, anorexia, and nausea and vomiting. Other findings include oliguria or anuria, proteinuria, hypoactive bowel sounds and, a day or two after infarction, a fever and increased blood pressure.
Renal papillary necrosis (acute).Acute renal papillary necrosis usually produces grossly bloody hematuria, which may be accompanied by intense flank pain, CVA tenderness, abdominal rigidity and colicky pain, oliguria or anuria, pyuria, fever, chills, vomiting, and hypoactive bowel sounds. Arthralgia and hypertension are common.
Renal trauma.About 80% of patients with renal trauma have microscopic or gross hematuria. Accompanying signs and symptoms may include flank pain, a palpable flank mass, oliguria, hematoma or ecchymoses over the upper abdomen or flank, nausea and vomiting, and hypoactive bowel sounds. Severe trauma may precipitate signs of shock, such as tachycardia and hypotension.
Renal tuberculosis.Gross hematuria is commonly the first sign of renal tuberculosis. It may be accompanied by urinary frequency, dysuria, pyuria, tenesmus, colicky abdominal pain, lumbar pain, and proteinuria.
Renal vein thrombosis.Grossly bloody hematuria usually occurs in renal vein thrombosis. In abrupt venous obstruction, the patient experiences severe flank and lumbar pain as well as epigastric and CVA tenderness. Other features include a fever, pallor, proteinuria, peripheral edema and, when the obstruction is bilateral, oliguria or anuria and other uremic signs. The kidneys are easily palpable. Gradual venous obstruction causes signs of nephrotic syndrome, proteinuria and, occasionally, peripheral edema.
Schistosomiasis.Schistosomiasis usually causes intermittent hematuria at the end of urination. It may be accompanied by dysuria, colicky renal and bladder pain, and palpable lower abdominal masses.
Sickle cell anemia.Sickle cell anemia is a hereditary disorder in which gross hematuria may result from congestion of the renal papillae. Associated signs and symptoms may include pallor, dehydration, chronic fatigue, polyarthralgia, leg ulcers, dyspnea, chest pain, impaired growth and development, hepatomegaly and, possibly, jaundice. Auscultation reveals tachycardia and systolic and diastolic murmurs.
Systemic lupus erythematosus (SLE).Gross hematuria and proteinuria may occur when SLE involves the kidneys. Cardinal associated features include nondeforming joint pain and stiffness, a butterfly rash, photosensitivity, Raynaud's phenomenon, seizures or psychoses, a recurrent fever, lymphadenopathy, oral or nasopharyngeal ulcers, anorexia, and weight loss.
Urethral trauma.Initial hematuria may occur, possibly with blood at the urinary meatus, local pain, and penile or vulvar ecchymoses.
Vasculitis.Hematuria is usually microscopic in vasculitis. Associated signs and symptoms include malaise, myalgia, polyarthralgia, a fever, increased blood pressure, pallor and, occasionally, anuria. Other features, such as urticaria and purpura, may reflect the etiology of vasculitis.
Other causes
Diagnostic tests.Renal biopsy is the diagnostic test most commonly associated with hematuria. This sign may also result from biopsy or manipulative instrumentation of the urinary tract such as in cystoscopy.
Drugs.Drugs that commonly cause hematuria are anticoagulants, aspirin (toxicity), analgesics, cyclophosphamide, metyrosine, phenylbutazone, oxyphenbutazone, penicillin, rifampin, and thiabendazole.
Treatments.Any therapy that involves manipulative instrumentation of the urinary tract, such as transurethral prostatectomy, may cause microscopic or macroscopic hematuria. Following a kidney transplant, a patient may experience hematuria with or without clots, which may require indwelling urinary catheter irrigation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urine cloudiness:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
UTI.Cloudy urine is common with UTI. Other urinary changes include urgency, frequency, hematuria, dysuria, nocturia and, in males, urethral discharge. Urinary hesitancy; bladder spasms; costovertebral angle tenderness; and suprapubic, lower back, or flank pain may occur. Other effects include fever, chills, malaise, nausea, and vomiting.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Proteinuria:
Proteinuria - pathophysiology
(The 5-Minute Pediatric Consult)
- ~50% of the normally excreted protein consists of Tamm-Horsfall protein, a glycoprotein secreted by the ascending loop of Henle.
- Proteinuria may be the result of an increased permeability of the glomeruli to the passage of serum proteins (glomerular proteinuria) or decreased reabsorption of low molecular weight proteins by the renal tubules (tubular proteinuria).
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
How your kidney stones are treated will depend on the size, location and type of stone you have. Our panel of experts will discuss the different...
Seventy-five percent of those advised by allergists to give up their pets choose not to. But there are steps you can take to relieve your suffering.
"I authorize the release of any medical or other information necessary to process this claim." Do you recognize these words? You should, if...
Sexual contact can sometimes result in problems. An unwanted pregnancy or sexually transmitted diseases may be some of those consequences. But by...
See full list of 4 related videos
» Next page: Risk Factors for Proteinuria
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
