A21-year-old man presents with painless haematuria which he has noticed in the last 3 days. He suffers from type 1 diabetes which is well controlled, but is otherwise fit and healthy. The patient has recently recovered from a mild throat infection. Urine dipstick analysis reveals blood and protein in the urine. The most likely diagnosis is:
A. HenochSchonlein purpura B. Benign prostate hypertrophy
C. IgA nephropathy
D. Diabetic nephropathy
E. Urinary tract infection (UTI)
The Answer
is. C. IgA nephropathy
Haematuria may be macroscopic with blood evident in the urine or
microscopic requiring urine dipstick testing. The anatomical origin of
macroscopic haematuria can often be deduced from its presentation in the urine,
although this should not be relied upon. Bleeding from the bladder or above
usually presents throughout voiding, terminal bladder or prostatic bleeding
occurs at the end of voiding, while urethral sites present at the beginning.
Microscopic haematuria identified by urine dipstick requires microscopic analysis
to confirm red blood cell presence. Red cell casts are red blood cells that
have leaked into renal tobules and clump together forming a cast-like structure
which is excreted into the urine. The presence of red cell casts are therefore
strongly suggestive of glomerular pathology. False-positive results may arise
from haemoglobin or myoglobin in the urine. IgA nephropathy or Berger’s disease
is the most common cause of glomerolonephritis and may present at any age.
Haematuria is usually acroscopic and occurs io intervals corresponding with
glomerular attacks, infections such as pharyngitis can exacerbate the
condition. Henoch— Schonlein purpura differs from Berger’s disease through more
systemic involvement, often presenting with arthritis of the large joints,
abdominal pain and a characteristic purpuric rash of the extensor skin
surfaces. The absence of pain and genital symptoms excludes a UTI. Diabetic
nephropathy typically presents with proteinuria and not haematuria. Benign
prostatic hypertrophy occurs in much older patients often alongside poor urine
flow.
