🩸 Hematuria · Glomerular vs Non‑glomerular · UTI, Stones, IgA, Alport

Schwartz Clinical Handbook — Chapter 39 · RBC morphology · Dysmorphic RBCs · RBC casts · Proteinuria · Hypertension · Hypercalciuria · Coagulopathy

Select urine color (cola, bright red, pink), associated symptoms (dysuria, edema, hypertension, flank pain), family history, and lab clues (proteinuria, RBC casts, hypercalciuria) → differentiate glomerular (IgA nephropathy, postinfectious GN, Alport) from non‑glomerular (UTI, stones, hypercalciuria, trauma) causes.
⚠️ Red flags: gross hematuria with hypertension, edema, oliguria, or RBC casts → glomerulonephritis, urgent nephrology referral.

📋 Step 1 — Urine color & associated symptoms
📌 Diagnostic impressions
📖 Schwartz Ch 39

Select urine color (cola‑colored vs bright red), dysuria, fever, edema, hypertension, flank pain, family history, and lab clues (RBC casts, proteinuria, hypercalciuria, sickle cell trait) → differentiate glomerular causes (IgA nephropathy, PSGN, Alport) from non‑glomerular (UTI, stones, hypercalciuria, urethrorrhagia, coagulopathy).

✔️ Glomerular: cola‑colored, RBC casts, dysmorphic RBCs, proteinuria, hypertension.
✔️ Non‑glomerular: bright red, clots, normal RBC morphology, no proteinuria.
✔️ Hypercalciuria: hematuria + normal exam + family stone history.
✔️ Sickle cell trait: hematuria in African‑American adolescent.
📘 Schwartz pearls (Chapter 39)
• RBC casts = glomerular bleeding (IgA, PSGN, lupus, Alport).
• PSGN: elevated ASO, low C3, resolves 6‑8 weeks.
• IgA nephropathy: gross hematuria 1‑2 days after URI.
• Hypercalciuria: urine Ca/Cr >0.2, 24h urine >4 mg/kg.
• Thin basement membrane disease: benign familial hematuria.