Glomitis

Glomerulonephritis

The impressive Michelle Sandoval created a review module on Glomerular Disease that you should definitely check out.

This urinalysis shows an RBC cast and suggests glomerular disease / inflammation at the level of the glomerulus. Erythrocytes may be distinct or incorporated into a homogenous mass. The most characteristic feature of a RBC cast is its orange-red appearance.

This is a great time to review a little about how we think about hematuria. The first question is always: Is it real? So confirm via repeat test and verification that bleeding is from urinary tract rather than mucosa trauma or vaginal source.

After you’ve confirmed that it really is hematuria, your next goal should be identifying the source as upper versus lower tract. This is where the urine sediment comes into play. For lower tract (i.e. NONglomerular) bleeding, you will see frank clot or normal looking erythrocytes. For upper tract (i.e. glomerular) bleeding, you will see RBC casts and dysmorphic RBCs. Once you have differentiated upper from lower tract, you can now target your next step to visualize the source. Glomerular bleeding warrants renal ultrasound and further work up of etiology whereas lower urinary tract bleeding warrants cystoscopy for direct visualization.

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