Hematuria is the presence of red blood cells in the urine. Visible hematuria, also known as gross hematuria, is easily identifiable, as it causes urine color changes in red or brown. Microscopic haematuria is invisible to the naked eye and is often discovered incidentally on urinalysis or urine dipstick. Any part of the kidneys or urinary tract (ureter, bladder, prostate, and urethra) can bleed into the urine. Causes of extensive hematuria, ranging from urinary tract infections to kidney stones to bladder cancer.
Microscopic haematuria is found regularly in routine urinalysis, with a prevalence of between 0.18% and 37%. Several studies have shown an increase in incidence with age and female sex, but others do not show correlation. In many people, no specific cause is found. Kidney, prostate, bladder, or testicular cancer is found in 5% of people with microscopic hematuria and up to 40% of those with visible hematuria. Haematuria is common in pediatric populations, with a prevalence of 0.5-2%.
Certain substances can mimic hematuria either by changing the color of urine or by causing false positives on urine dipstick. Causes of false positive urine dipstick include hemoglobin (without red blood cells), semen, myoglobin, porphyrin, betanin (after eating bits), and drugs (such as rifampicin, phenazopyridine, and sulfonamides). Substances that resemble hematuria cause red or brown urine changes including drugs (such as sulphonamides, quinine, rifampin, phenytoin), betanine, and menstruation.
Video Hematuria
Cause
Visible blood
Haematuria is seen to cause changes in brown or red color in the urine seen by the naked eye. It can be painful or painless.
Pain
- Kidney stones-suspected in someone with unilateral lower side pelvic pain radiating into the crotch, burning with urination, and fever
- Lower urinary tract infections or bladder-causing haematuria, white blood cells in the urine, and lower abdominal pain
- Pielonephritis, kidney infection-causes fever, white blood cells in urine, and pelvic pain
- Polycystic kidney disease - a genetic disorder that causes cysts in the kidney
- Trauma -including blunt trauma to the urinary tract or trailing traumatic traumatic catheter
Not painful
The most worrying cause of the invisible and painful blood in the urine is kidney or bladder cancer, especially in a person with risk factors such as male gender, age above 35 years, smoking history, chronic inflammation of the bladder, and occupational exposure (for aromatic amines and aniline dyes) â € <â €
Other causes include
- The exercise-induced haematuria-occurs in 30% of long-distance runners and often disappears within a few days of stopping
Children
More than 50% of cases of hematuria seen in children have identifiable causes. Common causes of haematuria seen in pediatric populations are:
- urinary tract infection
- perineal or urethral irritation
- congenital anomalies -
- Non-vascular - ureteropelvic connective obstruction, posterior urethral valve, urethral prolapse, urethral diverticula, multicystic dysplastic kidney
- Vascular - arteriovenous malformations, hereditary hemorrhagic telangiectasis, renal vascular thrombosis
- trauma
- acute nephritis - characterized by visible hematuria, white blood cells in urine, and temporary renal dysfunction, usually caused by drugs
- coagulopathy
- kidney stones
- IgA nephropathy-is suspected in children with dark urine and recent upper respiratory tract infections
- Post-streptococcal glomerulonephritis-suspected in children with dark brown urine after recent streptococcal pharyngitis or impetigo
Blood is not visible
Microscopic haematuria does not discolor urine and is thus discovered incidentally on urinalysis or light microscopy. It is defined as more than three red blood cells per high-powered field. In many of these cases, no source or cause is found. Any part of the kidney or urinary system may cause microscopic hematuria. The causes can be separated into glomeruli, arising from kidney, and non-glomerular, kidney filtering systems arising from the kidneys (outside the glomerulus), ureter, bladder, prostate, or urethra.
Glomerular
Inflammation or injury to glomeruli can lead to leakage of red blood cells, resulting in defective cells and red blood cells in the urine. Glomerular bleeding is often accompanied by proteinuria, or leakage of protein into the urine.
Common causes include
- IgA nephropathy
- Hereditary nephritis (Alport disease)
- Benign familial haematuria
- Glomerulonephritis - a group of inflammatory diseases of the glomeruli, causing haematuria, hypertension, and peripheral edema
Non-glomerular
- The three most common causes of microscopic hematuria are
- urinary tract infections of the ureters, bladder, prostate or urethra; signs including cloudy urine, urinary frequency, lower abdominal pain, and pain or burning during urination
- benign prostatic hyperplasia-signs include urinary frequency, nocturia, and prostate enlargement on rectal examination
- urinary tract stones-causing pain and burning during urination, unilateral pelvic pain, and fever
- Less common causes include
- bladder or ureteral polyp
- medullary sponge kidney
- hypercalciuria or hyperuricosuria
- heavy sports
- cancer or bladder or prostate tumor
- polycystic kidney disease
- renal papillary necrosis
- disease or sickle cell trait
Children
In many cases asymptomatic microscopic hematuria without proteinuria, no etiology is found. Common causes of microscopic hematuria in pediatric populations include:
- hypercalciuria-is suspected in children with a family history of kidney stones; can be asymptomatic or may cause painful urination
- benign familial haematuria - a genetic disorder that causes persistent microscopic haematuria
- IgA nephropathy
- sickle cell trait or disease
- Alport syndrome - a genetic disorder that causes recurrent microscopic haematuria with proteinuria, hearing loss, and progressive renal failure
Maps Hematuria
Diagnosis
Sometimes the cause of hematuria can be determined based on medical history and urine test. This is especially true for people younger than 35, where cancer risk is low. It is important to ascertain key risk factors such as smoking, occupational exposure to benzene, recent weight loss history and/or history of urological disorders such as benign enlargement of the prostate or recurrent kidney stones to assist with risk stratification. The two most common causes of haematuria are associated with kidney stones leading to obstruction or prostate or bladder infections. In addition, athletes with strong exercise regimens can sometimes have visible or microscopic hematuria.
The first step in the evaluation of Hematuria is by performing urine dipstick to assess blood in urine, followed by urinalysis with microscopic evaluation for confirmation. If hematuria is present, and is associated with acute onset of unilateral pelvic pain, it generally indicates the presence of kidney stones and evaluation should be performed with non contrast CT scans of the abdomen/pelvis. If hematuria is associated with fever, pain with urination, urinary frequency or presence of white blood cells in the urine; it is highly suggestive of urinary tract infections and additional work with urine culture should be done to evaluate further. If none of these features are present, the next step is to separate the evaluation into microscopic-looking hematuria.
Visible
For people with visible hematuria and evidence of blood clots, further imaging with abdominal CT scan should be performed and urgent referral for an urologist is made. Otherwise, the next step involves determining whether the source of glomerular bleeding in nature is evident in the presence of inappropriate/dysmorphic red blood cells, presence of protein in urine, new or worsening hypertension or swelling. If the source is a glomerular patient should be referred to a nephrologist for further evaluation. The source of non-glomerular bleeding will usually require further treatment by a urologist.
Microscopic
In people with microscopic hematuria, it is important to exclude the possibility of confounders such as menstruation in women, the possibility of semen present in a recent sample or strenuous exercise. In women who are menstruating, tests should be repeated during the non-bleeding parts of their cycle. In individuals with recent strenuous exercise history, urinalysis should be repeated 4-6 weeks after cessation of exercise. All women of childbearing age should undergo a pregnancy test, and if positive should receive their kidney and bladder ultrasound with further invasive diagnostic work postponed until completion of pregnancy.
If diagnostic tests have failed so far or risk factors mentioned above, it is important to start a thorough examination for possible malignancies especially in the bladder and kidney by referring to a Urologist to see the urethra and bladder with cystoscopy and also perform additional imaging using CT urography, which provides a holistic view of the complete urinary system.
For individuals with persistent haematuria with no identifiable immediate cause, urinalysis should be repeated once a year, and if negative for 2 years then you can stop repeating the test. However, if positive for 3 years, an anatomical evaluation should be performed.
Management
Hematuria management is aimed at treating secondary causes of haematuria. If hematuria is the result of UTI, treatment with antibiotics usually begins and the urine test is repeated after 6 weeks. If hematuria is secondary to kidney stones, then management depends on the size of the kidney stones. If the stone is small enough, usually less than 1 cm, then conservative management with analgesics and hydration fluid may be sufficient, but too large a stone may need to be issued by a urologist. Another common cause of hematuria is benign prostate enlargement (BPH), treatment aimed at reducing the size of the prostate with drugs such as finasteride and symptomatic management with drugs such as terazone or tamsulosin.
For people with exercise-induced haematuria, its management is conservative and involves cessation of severe activity and keeping it hydrated. If the cause of hematuria is a result of malignancy, treatment and management depends on the type and stage of the cancer and may involve chemotherapy, radiation or surgical resection of the tumor or organ involved.
References
External links
Media related to Hematuria in Wikimedia Commons
Source of the article : Wikipedia
0 Comments