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Propedeutics · Additional topics

Erythrocytes in urine

Haematuria

Hematuria is the pathological appearance of erythrocytes in the urine. It is one of the main components of the urinary syndrome and can range from a concealed microscopic presence to an overt change in the color of the excreted fluid.

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Types of hematuriaMicroscopic hematuria (visible only under a microscope) and gross hematuria (a change visible to the naked eye).
Specific colorIn gross hematuria, urine may acquire a characteristic "meat slops" or dark coffee appearance.
Nephritic syndromeHematuria is part of the classical triad along with arterial hypertension and edema.
2 min readFor medical studentsUpdated 10.10.2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesPending instructor review

General characteristics and types

Normally, erythrocytes are absent in the urine or detected in single quantities. A pathological increase in their number is called hematuria. Traditionally, two variants are distinguished:

  • Microscopic hematuria: detected exclusively by microscopic examination of the sediment.
  • Gross hematuria: accompanied by a visible change in urine color (up to the shade of "meat slops" or dark coffee).

Main causes of erythrocytes in urine

Hematuria often accompanies proteinuria and is observed in a wide range of diseases:

  • Various forms of glomerulonephritis.
  • Systemic lupus erythematosus (SLE) with renal involvement.
  • Chronic kidney disease (CKD), where hematuria serves as a marker of persistent cellular sediment damage.
  • Crush syndrome — accompanied by myoglobinuria with numerous erythrocytes in the sediment.
  • Infectious diseases (e.g., typhoid fever).
  • Renoparenchymal arterial hypertension.
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Differential diagnosis by leading syndrome

Evaluation of hematuria in combination with other symptoms allows for a rapid narrowing of the diagnostic search:

  1. Isolated hematuria. If erythrocytes in the urine are not accompanied by significant proteinuria and signs of nephritic syndrome, this is characteristic of urological pathology (urolithiasis, tumors, trauma), IgA nephropathy, or thin basement membrane disease.
  2. Hematuria as part of nephritic syndrome. The classical triad (hematuria + proteinuria + arterial hypertension + edema) indicates acute glomerulonephritis (e.g., acute post-streptococcal glomerulonephritis), which carries the risk of developing acute kidney injury.

Hematuria in acute infectious processes

In certain infections, erythrocytes appear in the urine transiently or during specific phases of the disease:

  • Acute post-streptococcal glomerulonephritis: develops 1–3 weeks after tonsillitis or 3–6 weeks after impetigo. In the first period (initial manifestations), pronounced gross hematuria occurs against the background of a sharp decrease in urine volume (oliguria). As symptoms resolve, gross hematuria disappears.
  • Hemorrhagic fever with renal syndrome (HFRS): in the febrile period, single fresh erythrocytes are detected in the sediment, and in the oliguric period, micro- and gross hematuria develop against the background of massive proteinuria and cylindruria.

Methods of quantitative evaluation

Nechiporenko test is used to clarify the severity of urinary sediment changes (including the number of formed elements such as erythrocytes and leukocytes). It involves the quantitative evaluation of elements in 1 ml of urine and allows for the objective assessment of the degree of hematuria and leukocyturia in a mild or obscured clinical presentation.

How to memorize

The triad of classical nephritic syndrome: HIE (Hematuria, Edema, Hypertension).

Class and exam questions

Can microscopic hematuria be seen with the naked eye?

No, microscopic hematuria is detected only by microscopic examination of the urinary sediment. A visual change in urine color is characteristic only of gross hematuria.

What does the presence of erythrocytes in urine without protein and edema indicate?

Isolated hematuria without prominent proteinuria and hypertension most often indicates urological problems (stones, trauma, tumors) or specific nephropathies (IgA nephropathy, thin basement membrane disease).

How does hematuria change during recovery from acute glomerulonephritis?

In the second period of the disease (resolution), gross hematuria disappears, diuresis is restored, and edema subsides. Laboratory urine parameters usually completely normalize within 1.5–2 months.

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What else to study on this topic

  • Mechanisms and causes of proteinuria development
  • Leukocyturia and bacteriuria as markers of infection
  • Types of casts in urine and their diagnostic significance
  • Clinical presentation of acute post-streptococcal glomerulonephritis
  • Dynamics of urinary syndrome in infectious diseases (HFRS, typhoid fever)
  • Difference between true anuria and acute urinary retention (ischuria)

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