Painless Hematuria

CLINICAL DIAGNOSTIC MANUAL

Painless hematuria is a clinical condition where blood is present in the urine without associated pain. This manifestation can be a sign of various pathologies, some of which may be serious, such as tumors of the urinary tract. Painless hematuria must be thoroughly evaluated to identify the underlying cause and ensure appropriate management.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Painless Hematuria	Presence of blood in the urine, absence of pain, urine with clots	Detailed clinical history, physical examination, urinalysis	Urine culture, renal and bladder ultrasound, urine cytology, cystoscopy
Renal Tumor	Painless hematuria, palpable abdominal mass, weight loss, fever	History of persistent hematuria, physical exam revealing abdominal mass	Abdominal and pelvic CT scan, renal ultrasound, renal biopsy
Ureteral Tumor	Painless hematuria, occasional lumbar pain, obstructive symptoms if the tumor is large	History of persistent hematuria, physical exam and obstructive symptoms	Intravenous urography, abdominal and pelvic CT scan, ureteroscopy with biopsy
Bladder Tumor	Painless hematuria, irritative urinary symptoms like frequency and urgency	History of persistent hematuria, irritative urinary symptoms	Urine cytology, cystoscopy with biopsy, abdominal and pelvic CT scan
Bleeding Diathesis	Painless hematuria, easy and prolonged bleeding in other parts of the body, frequent bruising	History of easy bleeding, abnormal coagulation tests	Coagulation tests (PT, aPTT, INR), specific studies of platelet function and coagulation factors
Urinary Tract Infection with Cystitis	Hematuria, dysuria (in some cases), urinary frequency and urgency, suprapubic pain (typically painful)	History of urinary symptoms, urinalysis showing leukocytes and nitrites	Positive urine culture, bladder ultrasound in recurrent cases
Glomerulonephritis	Hematuria, edema, hypertension, proteinuria	History of prior infections (e.g., streptococcal pharyngitis), urinalysis showing hematuria and proteinuria	Renal biopsy, blood tests showing altered renal function and elevated specific antibodies (e.g., anti-streptolysin O)
Polycystic Kidney Disease	Hematuria, abdominal or lumbar pain, hypertension, recurrent urinary infections	Family history of polycystic disease, physical exam, urinalysis	Renal ultrasound, abdominal and pelvic CT scan, MRI
Renal Trauma	Hematuria, abdominal or lumbar pain, signs of trauma in the affected area	History of recent trauma, physical exam revealing trauma signs	Renal ultrasound, abdominal and pelvic CT scan, urinalysis
Renal Tuberculosis	Hematuria, constitutional symptoms like fever, night sweats, weight loss, lumbar pain	History of tuberculosis exposure, systemic symptoms, urinalysis	Urine culture for Mycobacterium tuberculosis, abdominal and pelvic CT scan, specific imaging tests (e.g., intravenous pyelography)
Anticoagulant Medications	Painless hematuria, tendency to bleed easily, bruising	History of anticoagulant use, urinalysis showing red blood cells	Coagulation tests (PT, aPTT, INR), adjustment of anticoagulant dosage according to therapeutic levels