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Hematuria : Definition, Sign, Symptoms, Causes and Treatment

Wednesday, September 26th 2012. | General

Hematuria Definition

Hematuria indicates the presence of blood in the urine: it may or may not see with the naked eye and will be macroscopic or microscopic.

The presence of blood in the urine hematuria defined but it may be invisible to the naked eye (microscopic hematuria) and it will be detected by a urine dipstick.

Indeed, it is only from a speed of 300-500 red blood cells (RBCs) per mm3 of urine that we begin to see a pink in the urine (hematuria). When the amount of blood in the urine is more important, taking urine red tint frankly. Isolated hematuria is usually benign but must still exclude certain serious diagnoses (urological cancer, including kidney disease).

The prevalence of microscopic hematuria in a population without symptoms varies depending on the study between 0.2 and 21% (the latter in a population of elderly people with risk factors for urological diseases).

Hematuria

Hematuria Sign

Hematuria occurs in different ways depending on its cause.

Everything depends on the mechanism involved.

Namely a shock trauma of a kidney is an obvious cause of hematuria, but more often, the presence of red blood cells in the urine may be due to renal impairment (leaving the erythrocytes pass into the urine) or a bleeding problem along the urinary tract (kidneys going to the urinary opening) through the bladder.

The main cause urological hematuria are kidney stones present in the urinary tract or kidney cancer, bladder or urinary tract.

Hematuria Symptoms

If it is microscopic hematuria, there may be no symptoms and the discovery of hematuria may be occasional (dipstick performed occupational medicine for example). In the case of gross hematuria color pink, red or brown urine, by definition, visible to the naked eye.

Some symptoms may be present and be suspected cause urological hematuria: lumbar or pelvic pain, difficulty urinating, blood clots in the urine, pus in the urine (pyuria), the fact that the blood is especially this early urination (cause urethral or prostatic urethrovaginal) or at the end of urination (cause bladder).

When there are no symptoms, especially no pain, no difficulty in urinating and no blood clots or deposits in the urine, it is called isolated hematuria.

Hematuria Causes

Numerous pathologies may be the cause of hematuria.

Here is a list of diseases that can be the cause of hematuria. Most are related to maldie kidney or urinary tract, some dependent clotting disorders:

urine_checking

Hematuria Other Causes

Find the cause of hematuria is not simple: it is often necessary to perform additional tests.

It must be ensured that there is no urinary tract infection. For a woman, it must also ensure that bleeding does not come from a genital origin and thus repeat the examination outside the rules, and sometimes make a urinary catheter (for example metrorrhagia).

It will take a urine dipstick again after a few days if hematuria is likely to have been caused by physical exercise, sexual intercourse, infection, or menstruation (transient hematuria).

Must eliminate urethral bleeding (bleeding out urethra urination), but also causes non uro-nephrological color of urine: food coloring pigments (beetroot, red cabbage, blueberries, food coloring) or drug pigments (rifampicin, metronidazole, nitrofurantoin, phenindione, imipenem, laxatives). It can also be hemoglobin, bilirubin or myosin manufactured by the body.

In these cases, there is no red blood cells under a microscope.

Be careful not to reassure themselves too quickly attributing hematuria with anticoagulation or antiplatelet therapy. Must be further investigations.

Hematuria Tests

urine_test

The dipstick is very sensitive to detect haematuria. Just from May to October erythrocytes per mm3 for the result to be positive. However, it is believed that the presence of red blood cells in the urine is abnormal until about 10 erythrocytes per mm3, which partly explains the false positives. Sometimes used for other tests (urine cytology, in Addis) urine but many simply to affirm the dipstick haematuria.

A serum creatinine and 24-hour proteinuria may direct etiological research.

In addition to the questions and clinical examination he realized, the doctor may opt for a study of urinary sediment in phase contrast microscope. This simple procedure will allow us to analyze the shape of red blood cells in the urine: normal (80%) if the cause is urological erythrocytes deformed or grouped into a cylinder if the cause is renal (kidney glomeruli affected).

When renal glomerular confirmed, the nephrologist who quickly took things in hand. It is particularly interest him to consider a possible renal biopsy.

In other cases, several tests are available: intravenous urography, renal ultrasound, cystoscopy, urine cytology tumor scanner, NMRI (Nuclear Magnetic Resonance Imaging) and also crystalluria, and uraturie calciuria (in children and young adults are can detect hyperkalemia, hyperuricosuria or crystalluria in urine in about one out of three cases, which indicates that a metabolic disease, while no calculation does not appear on x-ray).

Hematuria is Serious?

Most often not, but it is essential to consult your doctor because it will eliminate the causes potentially serious (cancer, kidney disease …) or preventable (stones). Blood loss in the urine may seem impressive, but it is rarely important. Traumatic causes (including sudden deceleration with rupture of the renal artery in a car accident for example) in a context that must be taken care of in an emergency, however, the renal lesion itself is seldom endanger the patient’s life (but other injuries can). It may, however, permanently compromising kidney function affected.

Some patients with additional initial reassuring balance may develop cancer later. It is therefore important to keep track.Especially for patients with risk factors for cancer (eg smoking). The American Association of Urologists proposes, for example, to check blood pressure and remake a dipstick and urine cytology after 6 months, 1 year, 2 years and 3 years for patients with initial negative results despite microscopic hematuria without other symptoms (and, of course, make examinations immediately if symptoms reappear).

Hematuria Treatment

Hematuria is not in itself a disease, but it can be a sign. It is therefore the treatment of the cause is necessary.

References:

  • D.Joly Hematuria. Encycl Med Chir (Elsevier, Paris), Encyclopedia of Practical Medicine, 1-0660, 1998.
  • Izzedine H. Nephrology practice: how to interpret proteinuria, hematuria, abnormal serum sodium. Encycl Med Chir (Scientific and Medical Publishing Elsevier SAS, Paris all rights reserved). AKOS Encyclopedia of Practical Medicine, 5-0485, 2003.
  • G. Grossfeld et al. Asymptomatic Microscopic Hematuria in Adults: Summary of the AUA best practice policy recommendations. Am Fam Physician 2001; 63: 1145-1154.
  • Plant P. Conduct to be post-traumatic hematuria alone. Encycl Med Chir (Elsevier SAS, Paris, all rights reserved), Emergency, 24-181-A-10, 2003.
  • Gagnadoux MF. Proteinuria, hematuria and colored urine in children Encycl Med Chir (Elsevier SAS, Paris, all rights reserved), Pediatrics, 4-083-F-10, 2003.
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