HEMATURIA

Hematuria is a symptom that, when present, triggers a series of diagnostic assumptions requiring a number of important investigations to clarify its origin.
The first task is to get a description of the urine color: there is a significant difference between orange-red, brown-red, or bright red.
The medical history and the physical examination are very important, while the “the three glasses test” which was traditionally used to distinguish the origin of the hematuria (from the tract bladder-neck-to-prostate, or from the tract bladder-to-kidneys), has a limited value and has been replaced by more relevant investigations, such as ultrasound and endoscopy, spiral computed tomography, and nuclear magnetic resonance.
The causes are divided into extrarenal and systemic (coagulopathies, immune and neoplastic diseases, skin eruptions, arthritis, etc...), nephrologic (Glomerular, tubulo-interstitial, diabetic nephropathy and pregnancy nephrotic syndrome, as well as hereditary nephropathies (including Alport syndrome and Fabry syndrome, etc…), urological (congenital malformations, cancer, lithiasis and obstructive diseases), and, finally, inflammatory causes, like pielonephritis, cystitis, prostatitis and urethritis.
It is of paramount diagnostic importance to immediately obtain a urinalysis; a proteinuria greater than 1 g in 24 hours is considered to be significant for disease of the renal parenchyma, although a similar suggestion can be achieved by a value of 550 mg/24 hours; a value higher than 3 g is indicative of nephrotic syndrome.
Do not overlook the presence of asymptomatic hematurias, whose management requires prudential monitoring; their cause is often unknown, but fortunately is almost always of a benign nature, and free of consequences, and likely to be related to vascular malformations.