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Hematuria workup involves systematic evaluation to distinguish between glomerular and non-glomerular causes of blood in urine. The initial assessment includes urinalysis with microscopy, urine culture, and assessment of proteinuria to guide further diagnostic testing.
Glomerular hematuria results from damage to the glomerular basement membrane allowing red blood cells to pass into urine, often accompanied by proteinuria and RBC casts. Non-glomerular hematuria originates from the urinary tract (kidneys, ureters, bladder, urethra) due to stones, tumors, infections, or trauma, typically presenting with normal-appearing RBCs on microscopy.
The presence of RBC casts, proteinuria >500mg/day, and dysmorphic RBCs suggests glomerular disease requiring nephrology referral and possible kidney biopsy. Isolated hematuria without proteinuria or casts indicates non-glomerular causes, warranting cystoscopy and imaging studies to evaluate for urological pathology including malignancy.
Key imaging focus: Three-phase CT urogram for complete evaluation; US for initial screening