Hematuria
Encyclopedia : H : HE : HEM : Hematuria
In medicine, hematuria (or "haematuria") is the presence of blood in the urine. It is a sign of a large number of diseases of the kidneys and the urinary tract, ranging from trivial to lethal.
Occasionally "hemoglobinuria" is used synonymously, although more precisely it refers only to hemoglobin in the urine.
Contents
Types
Red decolouration of the urine can have various causes:- Red blood cells
- * Microscopic hematuria (small amounts of blood, can be seen only on urinalysis or light microscopy)
- * Macroscopic (or "frank" or "gross") hematuria
- Hemoglobin (only the red pigment, not the red blood cells)
- Other pigments (e.g., porphyrins in porphyria)
Analysis
A patient will be asked a number of questions:- Have you passed any blood clots?
- Has a kidney stone been passed (noise in toilet bowl)?
- Is the red colour mixed in completely, or does the colour change during an episode of urination?
- Does it occur only after getting up?
- Have you recently had a sore throat?
Diagnosis
Often, the diagnosis is made on the basis of the medical history and some blood tests—especially in young people in whom the risk of malignancy is negligible and the symptoms are generally self-limited.Ultrasound investigation of the renal tract is often used to distinguish between various sources of bleeding. X-rays can be used to identify kidney stones, although CT scanning is probably more precise.
In older patients, cystoscopy with biopsy of suspected lesions is often employed to investigate for bladder cancer.
Causes
Common causes of macroscopic hematuria (i.e. blood visible in the urine) include:- Benign familial hematuria
- Urinary Schistosomiasis (caused by Schistosoma haematobium) - a major cause for heamturia in many African and Middle-Eastern countries;
- IgA nephropathy ("Berger's disease") - occurs during viral infections in predisposed patients;
- Kidney stones (or bladder stones, now a rare disease);
- Bladder cancer;
- Renal cell carcinoma - occasionally presents with bleeding;
- Paroxysmal nocturnal hemoglobinuria - a rare disease where hemoglobin of hemolysed cells is passed into the urine; and
- Urinary tract infection with some bacterial species including strains of UPEC and Staphylococcus saprophyticus
- Sickle cell trait can precipitate large amounts of red blood cell discharge, but only a small number of individuals endure this problem
- Arteriovenous malformation of the kidney (rare, but may impress like renal cell carcinoma on scans as both are highly vascular)
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