Case 40-2004 - A 42-Year-Old Woman with Long-Standing Hematuria

doi:10.1056/NEJMcpc049031

Volume 351:2851-2859		December 30, 2004		Number 27

Case 40-2004 — A 42-Year-Old Woman with Long-Standing Hematuria

David J.R. Steele, M.D., and Paul J. Michaels, M.D.

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Presentation of Case

A 42-year-old woman visited the nephrology clinic for an evaluationof chronic microscopic hematuria.

Microscopic hematuria had been detected 14 years earlier duringan episode of cystitis. She subsequently had several episodesof cystitis each year, but the hematuria persisted after treatmentand resolution of the infections; usually there were 10 to 20red cells per high-power field on examination of the urine,but occasionally more than 100, with findings of trace to 1+proteinuria. An intravenous pyelogram obtained at the time ofthe initial diagnosis of hematuria was said to have shown aurethral stricture. Ten years before the . . . [Full Text of this Article]

Differential Diagnosis

Nonglomerular Causes of Microscopic Hematuria

Glomerular Causes of Microscopic Hematuria

IgA Nephropathy

Alport's Syndrome

Thin Basement Membrane Nephropathy

Differential Diagnosis of Alport's Syndrome and Thin Basement Membrane Nephropathy

Role of Renal Biopsy

Dr. David J.R. Steele's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Renal Unit, Department of Medicine (D.J.R.S.), and the Department of Pathology (P.J.M.), Massachusetts General Hospital; and the Departments of Medicine (D.J.R.S.) and Pathology (P.J.M.), Harvard Medical School.