Causes of Recurrent Hematuria
Recurrent hematuria, defined as repeated episodes of blood in the urine, can be caused by a variety of conditions affecting the kidneys, urinary tract, or systemic diseases. Common causes include:
- Glomerular causes:
- IgA nephropathy
- Alport syndrome
- Thin basement membrane nephropathy
- Non-glomerular causes:
- Urolithiasis (kidney stones)
- Urinary tract infections (UTIs)
- Renal or bladder trauma
- Malignancies:
- Renal cell carcinoma
- Transitional cell carcinoma of the bladder
- Systemic conditions:
- Vasculitis (e.g., Henoch-Schönlein purpura)
- Coagulopathy (bleeding disorders)
- Miscellaneous:
- Strenuous exercise (exercise-induced hematuria)
- Medications (anticoagulants, cyclophosphamide)
Diagnosis of Recurrent Hematuria
A thorough evaluation is necessary to pinpoint the underlying cause:
- History and physical examination:
- Timing of hematuria (initial, terminal, or throughout voiding)
- Associated symptoms (pain, fever, dysuria)
- Family and medication history
- Laboratory tests:
- Urinalysis: Presence of RBC casts or dysmorphic RBCs suggests glomerular origin.
- Urine culture: To rule out infection.
- Serum tests: Creatinine, eGFR, coagulation profile, complement levels.
- Imaging studies:
- Ultrasound: First-line for kidney and bladder evaluation.
- CT scan: For stones, malignancies, or vascular anomalies.
- MRI: If further soft-tissue differentiation is needed.
- Cystoscopy: Essential if malignancy or structural abnormality is suspected.
- Renal biopsy: For suspected glomerular causes like IgA nephropathy or Alport syndrome.
Management of Recurrent Hematuria
Management depends on the underlying etiology:
- Treat underlying infections:
- Address structural causes:
- Lithotripsy or surgery for stones.
- TURBT (Transurethral Resection of Bladder Tumor) for bladder cancer.
- Immunosuppressive therapy:
- Steroids or cytotoxic drugs for glomerulonephritis.
- Lifestyle modifications:
- Adequate hydration and dietary adjustments for stone prevention.
- Avoidance of strenuous exercise if exercise-induced hematuria is suspected.
