Chart — Renal
Hematuria Causes & Evaluation
Blood in the urine has many causes — the clues that sort them are pain, color, and company. The one rule to remember: painless gross hematuria is bladder cancer until proven otherwise.
Educational use only. Hematuria always warrants provider evaluation to find the source. This chart is an educational aid, not a diagnostic protocol. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Causes & Distinguishing Clues
| Cause | Distinguishing clue | Nursing action |
|---|---|---|
| Bladder / kidney cancer | PAINLESS gross hematuria (often intermittent), esp. in a smoker/older adult | Red flag — needs cystoscopy/urology workup; don't dismiss |
| UTI / cystitis | Hematuria with dysuria, frequency, urgency; cloudy/foul urine | Urinalysis/culture; treat infection |
| Kidney stones | Hematuria with severe colicky flank pain radiating to groin | Pain control, hydration, strain urine; non-contrast CT |
| Glomerulonephritis | Tea-/cola-colored urine, RBC casts, proteinuria, edema, hypertension | Nephrology workup; it's a glomerular (kidney) cause |
| BPH / prostate | Hematuria with obstructive urinary symptoms in older men | Evaluate prostate; still rule out cancer |
| Trauma / catheter / exercise | Recent injury, instrumentation, or vigorous exercise | Usually transient; reassess after the cause resolves |
| Anticoagulation / bleeding | On warfarin/DOAC/antiplatelet; may unmask another cause | Check coagulation; still evaluate the source |
Exam Traps
- ✦PAINLESS gross hematuria (esp. a smoker/older adult) = bladder cancer until proven otherwise — needs workup.
- ✦Hematuria WITH severe colicky flank pain = kidney stone; WITH dysuria/frequency = UTI.
- ✦Tea-/cola-colored urine + RBC casts + edema/HTN = glomerulonephritis (a kidney/glomerular cause).
- ✦Red urine isn't always blood — beets, rifampin, and phenazopyridine can discolor urine.
- ✦Anticoagulation can cause or unmask hematuria — still evaluate for an underlying source.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with KDIGO Clinical Practice Guidelines · National Kidney Foundation (NKF). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →