Persistent Hematuria With Late Diagnosis of Cardiac Origin: A Case Report

Area of Science:

• Nephrology
• Urology
• Cardiology

Background:

• Dark-colored urine is commonly misattributed to hematuria, necessitating differentiation from hemoglobinuria and myoglobinuria.
• Standard diagnostic approaches often focus on urologic causes, potentially overlooking systemic etiologies.
• Dipstick urinalysis alone can be insufficient for accurate diagnosis.

Observation:

• A case of persistent dark-colored urine was initially evaluated for urologic causes without success.
• The patient presented with hematuria that had cardiac origins, remaining undiagnosed for an extended period.
• This case underscores the limitations of isolated urologic assessment for dark urine.

Findings:

• Accurate diagnosis of dark-colored urine requires differentiating between true hematuria, hemoglobinuria, and myoglobinuria.
• Systemic evaluation, including detailed history and hematologic indices, is vital when urologic workup is unrevealing.
• Cardiac conditions can manifest as persistent hematuria, challenging conventional diagnostic pathways.

Implications:

• Clinicians should consider a broader differential diagnosis for dark-colored urine beyond common urologic sources.
• A comprehensive, systemic approach is essential for diagnosing rare causes of hematuria.
• Early identification of non-urologic causes of dark urine can prevent diagnostic delays and ensure appropriate management.