Hematuria
A streamlined, differential-led presentation for rapid clinical review.
Twenty-second review
- Hematuria may arise from infection, stone, malignancy, trauma, anticoagulation, glomerular disease, or instrumentation and can cause obstruction through clots.
- Shock, heavy bleeding or clots, urinary retention, trauma, anticoagulation, fever with flank pain, or single kidney is high risk.
- Keep vaginal or gi bleeding in the differential; overlapping or concurrent illness remains possible.
- For hematuria, trends and combinations of findings are more informative than one isolated vital sign.
Compare the clinical patterns
The repeated material is grouped inside each possibility. Open only the condition you need.
Renal traumaTime-sensitive high-risk possibility
HPI
Clarify gross or microscopic report; pain, clots or retention; trauma or procedure.
Signs & symptoms
Mechanism, persistent gross blood, fever, or shock.
Focused exam
Assess hydration, edema, lung sounds, bladder or flank tenderness, urine appearance, and dialysis access when relevant; Obtain a 12-lead ECG when electrolyte disturbance is plausible.
Brief pathophysiology
Renal trauma may cause hematuria through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.
Temperature (°C)
Trend temperatureFever or hypothermia raises concern for systemic infection.
Blood pressure (mmHg)
High or lowRenal disease, volume overload, or dehydration can alter pressure in either direction.
Heart rate (bpm)
May risePain, fever, dehydration, and shock can increase rate.
Respiratory rate (breaths/min)
May riseTachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.
Front-load in the triage report
- Renal trauma: Mechanism, persistent gross blood, fever, or shock.
- Gross or microscopic report?
- Pain, clots or retention?
Malignancy-related bleedingTime-sensitive high-risk possibility
HPI
Clarify pain, clots or retention; trauma or procedure; anticoagulants.
Signs & symptoms
Mechanism, persistent gross blood, fever, or shock.
Focused exam
Obtain a 12-lead ECG when electrolyte disturbance is plausible; Confirm apparent source, assess urine colour and clots, bladder and flank tenderness, trauma, catheter function, perfusion, and medications.
Brief pathophysiology
Malignancy-related bleeding may cause hematuria through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.
Temperature (°C)
Trend temperatureFever or hypothermia raises concern for systemic infection.
Blood pressure (mmHg)
High or lowRenal disease, volume overload, or dehydration can alter pressure in either direction.
Heart rate (bpm)
May risePain, fever, dehydration, and shock can increase rate.
Respiratory rate (breaths/min)
May riseTachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.
Front-load in the triage report
- Malignancy-related bleeding: Mechanism, persistent gross blood, fever, or shock.
- Pain, clots or retention?
- Trauma or procedure?
Infected obstructionTime-sensitive high-risk possibility
HPI
Clarify trauma or procedure; anticoagulants; fever or urinary symptoms.
Signs & symptoms
Mechanism, persistent gross blood, fever, or shock.
Focused exam
Obtain a 12-lead ECG when electrolyte disturbance is plausible; Confirm apparent source, assess urine colour and clots, bladder and flank tenderness, trauma, catheter function, perfusion, and medications.
Brief pathophysiology
Infected obstruction may cause hematuria through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.
Temperature (°C)
Trend temperatureFever or hypothermia raises concern for systemic infection.
Blood pressure (mmHg)
High or lowRenal disease, volume overload, or dehydration can alter pressure in either direction.
Heart rate (bpm)
May risePain, fever, dehydration, and shock can increase rate.
Respiratory rate (breaths/min)
May riseTachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.
Front-load in the triage report
- Infected obstruction: Mechanism, persistent gross blood, fever, or shock.
- Trauma or procedure?
- Anticoagulants?
UTICommon presentation pattern
HPI
Clarify gross or microscopic report; pain, clots or retention; trauma or procedure.
Signs & symptoms
Dysuria, colic, or recent catheter procedure may support the source.
Focused exam
Assess hydration, edema, lung sounds, bladder or flank tenderness, urine appearance, and dialysis access when relevant; Obtain a 12-lead ECG when electrolyte disturbance is plausible.
Brief pathophysiology
UTI may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.
Temperature (°C)
Trend temperatureFever or hypothermia raises concern for systemic infection.
Blood pressure (mmHg)
High or lowRenal disease, volume overload, or dehydration can alter pressure in either direction.
Heart rate (bpm)
May risePain, fever, dehydration, and shock can increase rate.
Respiratory rate (breaths/min)
May riseTachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.
Front-load in the triage report
- Dysuria, colic, or recent catheter procedure may support the source.
- Gross or microscopic report?
- Pain, clots or retention?
StoneCommon presentation pattern
HPI
Clarify pain, clots or retention; trauma or procedure; anticoagulants.
Signs & symptoms
Dysuria, colic, or recent catheter procedure may support the source.
Focused exam
Obtain a 12-lead ECG when electrolyte disturbance is plausible; Confirm apparent source, assess urine colour and clots, bladder and flank tenderness, trauma, catheter function, perfusion, and medications.
Brief pathophysiology
Stone may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.
Temperature (°C)
Trend temperatureFever or hypothermia raises concern for systemic infection.
Blood pressure (mmHg)
High or lowRenal disease, volume overload, or dehydration can alter pressure in either direction.
Heart rate (bpm)
May risePain, fever, dehydration, and shock can increase rate.
Respiratory rate (breaths/min)
May riseTachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.
Front-load in the triage report
- Dysuria, colic, or recent catheter procedure may support the source.
- Pain, clots or retention?
- Trauma or procedure?
InstrumentationCommon presentation pattern
HPI
Clarify trauma or procedure; anticoagulants; fever or urinary symptoms.
Signs & symptoms
Dysuria, colic, or recent catheter procedure may support the source.
Focused exam
Obtain a 12-lead ECG when electrolyte disturbance is plausible; Confirm apparent source, assess urine colour and clots, bladder and flank tenderness, trauma, catheter function, perfusion, and medications.
Brief pathophysiology
Instrumentation may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.
Temperature (°C)
Trend temperatureFever or hypothermia raises concern for systemic infection.
Blood pressure (mmHg)
High or lowRenal disease, volume overload, or dehydration can alter pressure in either direction.
Heart rate (bpm)
May risePain, fever, dehydration, and shock can increase rate.
Respiratory rate (breaths/min)
May riseTachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.
Front-load in the triage report
- Dysuria, colic, or recent catheter procedure may support the source.
- Trauma or procedure?
- Anticoagulants?
VaginalImportant alternative presentation
HPI
Clarify gross or microscopic report; pain, clots or retention; trauma or procedure.
Signs & symptoms
Source may be misidentified without careful history.
Focused exam
Assess hydration, edema, lung sounds, bladder or flank tenderness, urine appearance, and dialysis access when relevant; Obtain a 12-lead ECG when electrolyte disturbance is plausible.
Brief pathophysiology
Vaginal can resemble hematuria through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Genitourinary and renal differentials can involve pain, infection, volume change, or metabolic disturbance. These observations help distinguish local from systemic illness.
Temperature (°C)
Trend temperatureFever or hypothermia raises concern for systemic infection.
Blood pressure (mmHg)
High or lowRenal disease, volume overload, or dehydration can alter pressure in either direction.
Heart rate (bpm)
May risePain, fever, dehydration, and shock can increase rate.
Respiratory rate (breaths/min)
May riseTachypnea may reflect sepsis, acidosis, pain, or pulmonary edema.
Front-load in the triage report
- Source may be misidentified without careful history.
- Gross or microscopic report?
- Pain, clots or retention?
GI bleedingImportant alternative presentation
HPI
Clarify pain, clots or retention; trauma or procedure; anticoagulants.
Signs & symptoms
Source may be misidentified without careful history.
Focused exam
Obtain a 12-lead ECG when electrolyte disturbance is plausible; Confirm apparent source, assess urine colour and clots, bladder and flank tenderness, trauma, catheter function, perfusion, and medications.
Brief pathophysiology
GI bleeding can resemble hematuria through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Hemorrhage is a trend diagnosis: tachycardia and narrowing pulse pressure may precede hypotension. Age, pregnancy, medications, and pacing can blunt expected responses.
Heart rate (bpm)
Often risesTachycardia is a common compensatory response but may be absent.
Pulse pressure (mmHg)
May narrowNarrowing pulse pressure can reflect reduced stroke volume.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude significant compensated hemorrhage.
MAP (mmHg)
May fallA falling trend supports worsening perfusion; interpret with mental status and skin signs.
Front-load in the triage report
- Source may be misidentified without careful history.
- Pain, clots or retention?
- Trauma or procedure?
Findings that should escalate concern
- Shock, heavy bleeding or clots, urinary retention, trauma, anticoagulation, fever with flank pain, or single kidney is high risk.
- Renal trauma, malignancy-related bleeding, or infected obstruction: Mechanism, persistent gross blood, fever, or shock.
Medication recognition
Continue the clinical pathway
Clinical and academic sources
Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.
BCEHS Handbook — specific CPGs
Supporting clinical and academic evidence
- CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians
Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.
- Acute kidney injury: prevention, detection and managementNational Institute for Health and Care Excellence
Clinical guidance for recognizing renal risk, oliguria, obstruction, electrolyte complications, and deterioration.
- Clinical Significance, Differential Diagnosis and Initial Management of HematuriaCureus · 2025
Differential diagnosis, clot retention, infection, trauma, anticoagulation, and initial hematuria assessment.