Hematuria (gross)MANAGEMENT

GENITOURINARY AND REPRODUCTIVE PRESENTATIONS · 12 SECTIONS

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509 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Acute Kidney Injury (ATN)Acute Kidney Injury (Post-renal)Acute Kidney Injury (Pre-renal)Amniotic Fluid Embolism Balanitis Bladder Rupture Breast Abscess Cystitis Dialysis access complications Ectopic pregnancy Epididymitis Glomerulonephritis Hematuria (gross)Hydrocele Interstitial Cystitis Mastitis Mittelschmerz Nephrolithiasis Nephrotic Syndrome Flare Nutcracker Syndrome Orchitis Ovarian Cyst Rupture Ovarian hyperstimulation syndrome Ovarian torsion Paraphimosis Pelvic Congestion Syndrome Pelvic Inflammatory Disease (PID)Peritoneal dialysis peritonitis Phimosis Priapism Prostatitis Pyelonephritis Renal laceration Renal transplant complications and rejection Ruptured ovarian cyst Testicular torsion Torsion of Appendix Testis Tubo-ovarian abscess Ureteral Rupture Urethritis Urinary Retention Urinary tract infection (uncomplicated)Urolithiasis (renal colic)Vaginal bleeding (non-pregnant)Vaginitis (Bacterial)Vaginitis (Candidal)Varicocele Vulvovaginal Hematoma

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp60

Immediate stabilization

›High risk presentation

›Hemodynamic instability

›Escalate to resuscitation bay for SBP < 90 mmHg

›Escalate to resuscitation bay for altered mental status

›Ongoing brisk bleeding

›Activate massive transfusion protocol for suspected hemorrhagic shock

›Early urology consult for suspected clot retention with obstruction

›Urinary obstruction

›If inability to void with suprapubic pain, treat as clot retention until proven otherwise

›If anuria with flank pain, urgent imaging for obstruction

›Initial monitoring

›Continuous cardiac monitoring

›Telemetry for active bleeding or anemia

›Frequent blood pressure checks

›Arterial line if rapidly changing hemodynamics

›Strict intake and output

›Urine output target 0.5 ml/kg/hour

›Access and resuscitation

›Two large bore IV lines

›If difficult access, intraosseous access

›Balanced crystalloid only for temporizing hypotension

›Transition to blood products for suspected hemorrhagic shock

›Transfusion thresholds

›If active bleeding, transfuse based on physiology and ongoing loss rather than a single hemoglobin value

›If coronary disease or symptoms, consider higher hemoglobin threshold

Time critical causes and triggers

›Cannot miss etiologies

02History/hx67

Presenting features

›Symptom characterization

›Gross hematuria timing

›Initial stream

›Terminal stream

›Total stream

›Clots

›Clot passage

›Urinary retention episodes

›Pain pattern

›Flank colic pattern

›Suprapubic pain pattern

›Painless hematuria

›Associated urinary symptoms

›Dysuria

›Frequency

›Urgency

›Systemic symptoms

›Fever

›Weight loss

›Timing and exposures

›Recent trauma

›Blunt abdominal trauma

›Straddle injury

›Recent procedures

›Foley catheterization

›Cystoscopy

›Ureteroscopy

03Physical Exam/exam44

General and hemodynamics

›Stability assessment

›Vital signs

›Hypotension

›Tachycardia

›Perfusion

›Delayed capillary refill

›Cool extremities

›Mental status

›Confusion

›Syncope

›Bleeding burden clues

›Pallor

›Conjunctival pallor

›Volume status

›Orthostasis

›Visible urine inspection

›Red urine

›Tea or cola urine

Abdominal and genitourinary exam

›Abdominal findings

›Costovertebral angle tenderness

›Unilateral

›Bilateral

›Suprapubic tenderness

›Distended bladder

›Palpable mass

›Renal mass concern

04Differential Diagnosis/ddx49

Life threatening and high consequence

›Immediate threats

›Malignancy

›Bladder cancer

›ICD-10 C67

›Renal cell carcinoma

›ICD-10 C64

›Upper tract urothelial carcinoma

›ICD-10 C65 C66

›Severe bleeding or obstruction

›Clot retention with urinary obstruction

›ICD-10 R33

›Hemorrhagic shock

›ICD-10 R57.1

›Infected obstruction

›Obstructing stone with sepsis

›ICD-10 N20 with A41

Common etiologies by pattern

›Painful hematuria

›Urolithiasis

›ICD-10 N20

›Pyelonephritis

›ICD-10 N10

›Cystitis

›ICD-10 N30

›Trauma

›Renal contusion laceration

›Painless hematuria

05Laboratory Tests/lt45

Core labs

›Initial laboratory panel

›Urinalysis with microscopy

›RBC count confirmation

›RBC morphology

›Proteinuria

›Casts

›Complete blood count for anemia and infection

›Hemoglobin trend if ongoing bleeding

›Platelet count for bleeding risk

›Basic metabolic panel for kidney function

›Creatinine baseline for imaging planning

›Potassium for obstruction and AKI

Hemostasis and transfusion

›Coagulation assessment

›INR for warfarin effect

›Therapeutic vs supratherapeutic

›aPTT if heparin exposure

›Excess anticoagulation concern

›Fibrinogen if massive bleeding

›Low fibrinogen replacement trigger

›Type and screen

›Active bleeding

›Crossmatch for anticipated transfusion

›Planned operative intervention

›Pre procedure preparation

Infection and systemic workup

›Infection evaluation

06Diagnostic Tests/dt43

Scoring Systems

›Hematuria risk stratification

›AUA risk concepts

›Gross hematuria as high risk for malignancy

›Older age and smoking as higher risk features

›Glomerular vs non glomerular pattern

›Proteinuria and casts supporting glomerular source

›Clots supporting lower tract source

MRI

›MRI urography

›Indications

›Iodinated contrast allergy with need for upper tract imaging

›Pregnancy selected cases after risk benefit discussion

›Limitations

›Lower sensitivity for small urothelial lesions vs CT urography

›Limited acute ED availability

›CT selection by syndrome

›CT urogram multiphase

›High risk hematuria evaluation

›Upper tract urothelial assessment

›CT KUB non contrast

›Suspected stone disease

›Flank pain with hematuria

›CT abdomen pelvis with IV contrast

›Suspected renal mass

›Trauma evaluation per protocol

›Contrast safety

07Disposition/dispo30

Admission and level of care

›Admission criteria

›Hemodynamic instability or syncope

›ICU or stepdown depending on support needs

›Ongoing transfusion requirement

›Monitored bed

›Clot retention

›Urology admission or observation with irrigation plan

›Infected obstruction

›Emergent urology intervention pathway

›Transfer criteria

›No urology coverage with clot retention

›Transfer after stabilization and catheter placement

›Suspected malignancy with severe bleeding needing intervention

›Transfer to center with endoscopic capabilities

Discharge criteria and follow up

›Discharge suitability

›Hemodynamically stable

›No orthostasis

›No clot retention

›Adequate spontaneous voiding

›Hemoglobin stable on repeat testing when clinically indicated

›No concerning downtrend

›Pain controlled with oral regimen

›Tolerating oral intake

›Follow up plan

›Gross hematuria

›Urology referral for cystoscopy and upper tract imaging

08Treatment/t75

Immediate urinary tract management

›Clot retention pathway

›Three way catheter placement

›Large bore catheter

›22 to 24 Fr preferred for clot evacuation

›If urethral trauma concern, urology before catheterization

›Retrograde urethrogram pathway

›Manual irrigation

›Sterile saline irrigation until return clears of clots

›If inability to clear, urgent urology for cystoscopic evacuation

›Continuous bladder irrigation

›Initiate CBI after large clots cleared

›Titrate irrigation rate to light pink effluent

Hemorrhage and anemia

›Transfusion

›Packed RBC transfusion

›If symptomatic anemia

›Chest pain

›Dyspnea

›Syncope

›If ongoing brisk bleeding with instability

›Transfuse without waiting for labs

›Platelets

›If severe thrombocytopenia with active bleeding

›If platelet dysfunction with life threatening bleeding

›Hemostatic adjuncts

›Intravesical agents

›Alum irrigation

09Special Populations/sp29

Pregnancy

›Pregnancy considerations

›Source clarification

›Vaginal bleeding vs hematuria

›Placental causes outside urinary tract

›Imaging strategy

›Renal bladder ultrasound first line for stones

›MRI urography as second line when needed

›Medication safety

›Avoid NSAIDs in later pregnancy

›Antibiotic selection pregnancy safe options

Geriatric

›Older adult considerations

›High malignancy pretest probability

›Expedite urology follow up for cystoscopy

›Medication risks

›Anticholinergic delirium risk

›NSAID renal and GI risk

›Anticoagulant use prevalence

›Lower threshold for coagulation testing and reversal discussion

Pediatrics

›Pediatric considerations

›Common etiologies

›Post infectious glomerulonephritis

›Hypercalciuria

›Trauma

›Imaging strategy

›Ultrasound first line for stones

10Background/b37

Epidemiology

›Frequency and significance

›Gross hematuria as high risk symptom

›Increased probability of urologic malignancy vs microscopic hematuria

›Age distribution

›Malignancy risk increases with age

›Smoking association

›Strong risk factor for urothelial carcinoma

Pathophysiology

›Source categories

›Glomerular bleeding

›Dysmorphic RBC and casts

›Proteinuria common

›Nonglomerular renal bleeding

›Stones

›Tumor

›Infection

›Lower tract bleeding

›Bladder tumor

›Prostate bleeding

›Cystitis

›Clot formation mechanisms

›Lower tract bleeding more likely to clot

›Clots suggest bladder or prostate source

›Obstruction pathway

›Clot ball valve effect

›Retention and hydronephrosis risk

11Patient Discharge Instructions/pdi21

copy discharge instructions

›Discharge instructions

›Diagnosis

›Blood in urine

›Home care

›Hydration

›Avoid strenuous exercise for 48 hours if exercise related

›Medication review with prescriber for blood thinners

›Follow up

›Urology appointment for cystoscopy and imaging

›Primary care visit for lab review if kidney function abnormal

›Return to ED now

›Inability to urinate

›Large clots

›Worsening bleeding

›Dizziness or fainting

›Chest pain

›Fever

›Severe flank pain

›Coding references

›ICD-10 R31.0 gross hematuria

›SNOMED CT gross hematuria concept

12References/r9

Guidelines and key sources

›Evidence sources

›American Urological Association hematuria guidance

›Gross hematuria generally warrants cystoscopy and upper tract imaging

›ACEP clinical policy concepts for urinary tract emergencies

›Hemodynamic instability triggers resuscitation and transfusion pathways

›Coding systems

›ICD-10 R31.0 gross hematuria

›ICD-10 R31.9 hematuria unspecified

›SNOMED CT hematuria and gross hematuria concepts

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.