ASYMPTOMATIC URINARY ABNORMALITIES : Hematuria and Proteinuria - 11/09/11

Doi : 10.1016/S0025-7125(05)70537-X

Ziauddin Ahmed, MD, FACP ^{^{*
From the Department of Medicine, Allegheny University of Health Sciences, Philadelphia, Pennsylvania}}, Jean Lee, MD, FACP ^{^{*
From the Department of Medicine, Allegheny University of Health Sciences, Philadelphia, Pennsylvania}}

Résumé

Abnormalities detected in routine urinalysis in patients who have no symptoms of renal or urologic disease are a common finding in clinical practice. Appropriate evaluation of such abnormalities can lead to detection of serious underlying diseases in asymptomatic patients. Urinary abnormalities are an index of structural renal disease (e.g., red cell cast in glomerulonephritis) and other systemic diseases. Urinalysis (with microscopic examination of urine sediment), when properly done and interpreted by a knowledgeable person, can be a guide for further evaluation of renal disease and may help to avoid unnecessary investigation. Because they are not always intrinsically related, the abnormal results of the components of the urinalysis may occur alone or in combination.

Asymptomatic urinary abnormalities that are commonly diagnosed by dipstick and microscopic examination of urine are glycosuria, pyuria, crystalluria, bacteriuria, hematuria, and proteinuria:

•	Glycosuria: Glycosuria in the absence of hyperglycemia suggests renal glycosuria or proximal tubular disease. This condition is also common in pregnancy.
•	Pyuria: Presence of more than 3 to 5 white blood cells/high-power field in the absence of positive urine culture suggests interstitial nephritis, prostatitis, or renal tuberculosis.
•	Crystalluria: Crystals of many types appear in the urine sediment of asymptomatic patients. Most of them have no diagnostic significance, but hexagonal cystine crystals are seen only in the urine of patients with cystinuria.
•	Bacteriuria: Asymptomatic bacteriuria is frequently contaminant in women, but in pregnant women and in children, it is a useful guide for further evaluation for urinary tract infection.
•	Hematuria and proteinuria: Hematuria and proteinuria can be symptomatic or asymptomatic and are commonly associated with significant underlying diseases and dictate detailed discussion.

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Plan

HEMATURIA

Transient Versus Persistent Hematuria

Address reprint requests to Ziauddin Ahmed, MD, FACP, Division of Nephrology, Allegheny University–East Falls, 3300 Henry Avenue, Philadelphia, PA 19129