Differential diagnosis of haematuria: glomerular or non-glomerular haematuria?

Authors

  • Patricia Ramos Mayordomo Resident Pharmacist. Clinical Analysis Service. Río Hortega University Hospital, Valladolid, Spain.
  • Marta Capilla Díez Specialist Physician in Clinical Analysis. Clinical Analysis Service. Río Hortega University Hospital, Valladolid, Spain. https://orcid.org/0009-0002-5292-1998

DOI:

https://doi.org/10.24197/5283t937

Keywords:

glomerular haematuria, non-glomerular haematuria, dysmorphic red blood cells, acanthocytes, phase contrast microscopy

Abstract

Haematuria is defined as the presence of >12 red blood cells (RBCs)/μL (2-3 RBCs/high-power field 40×) in the urinary sediment in men or >30 RBCs/μL (>5 RBCs/high-power field 40×) in women or children and this finding is considered pathological. To characterize haematuria, it is necessary to assess for macroscopic changes and to perform both a chemical urine analysis (dipstick testing) and a microscopic examination of the urinary sediment, this being the gold standard for its detection and confirmation.

This image illustrates the approach to the differential diagnosis of haematuria, emphasizing the key role of the Clinical Laboratory in performing urinalysis and interpreting the pathophysiological significance of urinary formed elements, helping to guide clinicians toward an accurate diagnosis.

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References

— Fogazzi GB, Garigali G, Abinti M, Lieti G, Verdesca S. An updated approach to the evaluation of the urinary sediment. Pediatr Nephrol. 2025 Apr;40(4):933-945.

— Zaera S, Villar-Mallo N, González Vilanova M, Díaz Lozano MC, Garrido-Sánchez JJ, Máiz Suárez L. About the correct definition of acanthocytes for their use as markers of glomerular haematuria. Rev Lab Clin. 2019 Jul 1;12(3):155–157.

— Jiménez García JA, Ruiz Martín G. El Laboratorio Clínico 2: Estudio de los elementos formes de la orina. Estandarización del sedimento urinario. Cuenca (España): LABCAM (Asociación Castellano‑Manchega de Análisis Clínicos); 2010.

— Carrasco Hidalgo-Barquero M, de Cea Crespo JM. Hematuria. Protoc diagn ter pediatr. 2014;1:53-68.

— Jayne D. Hematuria and proteinuria. In: Greenberg A, editor. Primer on Kidney Diseases. Philadelphia: Saunders Elsevier; 2009. p. 33–42.

Autora: Dra. Irene Martín de Prado

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Published

2025-10-23

Issue

No. 30 (2025): CLÍNICA

Section

Imágenes/Infografías

License

Copyright (c) 2025 Patricia Ramos Mayordomo, Marta Capilla Díez

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