S2D: The Symptom to Diagnosis Podcast Hematuria
Jun 9, 2021
This episode dives into the intriguing case of hematuria, starting with a surprising presentation of reddish-brown urine after a hike. The discussion touches on differential diagnoses, exploring the implications of color and potential causes like rhabdomyolysis. Key principles for evaluation are outlined, emphasizing that common issues can present in unusual ways. Imaging reveals a ureteral stone as the culprit, reminding listeners that hematuria assessments are crucial, even with anticoagulation. Clinical pearls and misconceptions are tackled, making for an insightful clinical conversation.
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Episode notes
Physician’s Personal Hematuria Story
- Adam Seafew described his own episode: reddish‑brown urine after a long Hawaiian hike that resolved with hydration.
- The transient event and absence of other symptoms prompted later outpatient evaluation.
Red Urine Isn’t Always Blood
- Not all red urine is true hematuria; pigmenturia (beets, rifampin, phenazopyridine) and pigment from bilirubin, myoglobin, or free hemoglobin can mimic blood.
- A urine dip and microscopy distinguish pigmenturia from true red cells and guide further workup.
Glomerular Versus Non‑Glomerular Bleeding
- First separate glomerular versus non‑glomerular hematuria by urine microscopy for dysmorphic RBCs or red cell casts.
- Glomerular causes often show proteinuria, hypertension, or AKI and need nephrology input.
