Emergency Medicine Emergency Medicine · Urology · High Yield

Haematuria Causes

Haematuria is blood in the urine — visible (macroscopic) or detected on dipstick (microscopic). Any visible haematuria without a urological cause must be assumed malignant until proven otherwise.

✦ The Mnemonic

"UBTS Causes Haematuria — Upper, Bladder, Tumour, Stones"

Tumour (bladder/renal) · Stone · Infection · Glomerulonephritis · Trauma · BPH

T Tumour — bladder Transitional cell carcinoma — most common; painless macroscopic haematuria; urgent cystoscopy
T Tumour — renal RCC; Wilms' (nephroblastoma — children); classical triad: haematuria, flank mass, flank pain
S Stone Ureteric colic; colicky loin-to-groin pain with haematuria; CT KUB
I Infection UTI; most common cause of microscopic haematuria; treat infection and recheck dipstick
G Glomerulonephritis IgA nephropathy (most common GN — episodic haematuria post-URTI); Alport syndrome
Tr Trauma Renal trauma; urethral injury (blood at meatus); contrast CT if high-velocity trauma
B BPH Benign prostatic hyperplasia; microscopic haematuria in men over 50; PSA + flow studies

📚 Clinical Breakdown

Investigation: all patients with unexplained visible haematuria or non-visible haematuria aged >40 require urgent referral for cystoscopy + upper tract imaging (CT urogram). After UTI is treated, recheck urinalysis — if haematuria persists, refer.

IgA nephropathy (Berger's disease): most common primary GN worldwide. Presents with macroscopic haematuria during or shortly after an URTI (synpharyngitic haematuria — concurrent with pharyngitis, in contrast to post-streptococcal GN which occurs 2–3 weeks after). Elevated serum IgA. Renal biopsy: mesangial IgA deposits.

Bladder cancer risk factors: smoking (most important — aniline dye metabolites concentrated in urine), aniline dyes (textile/rubber industry), cyclophosphamide, pelvic irradiation, schistosomiasis (causes squamous cell carcinoma — not TCC). Painless visible haematuria in a smoker = bladder cancer until proven otherwise.

Painless visible haematuria Bladder cancer until proven otherwise
Most common GN IgA nephropathy
CT KUB for Renal stone — non-contrast
CT urogram for Haematuria full investigation — upper + lower tract

⭐ Clinical Pearl

Microscopic haematuria definition: ≥3 RBCs per high-power field on microscopy, or a positive dipstick on two of three samples. Isolated microscopic haematuria in a young woman is most commonly a UTI — always treat infection and recheck. False positive dipstick: myoglobinuria, haemoglobinuria, povidone-iodine contamination.

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