Gynecology

Hematuria: causes, symptoms, treatment

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The human excretory system reacts to every disease in the body, since biological and chemical toxins are usually excreted by the kidneys. The pathological process, localized directly in the kidneys, may contribute to an increase in the permeability of the membrane of the renal glomeruli, as a result of which blood cells are leaking. A condition that is manifested by the presence of red blood cells in the urine is called hematuria. What it is? What are the causes of this phenomenon? What treatment is required? These and other issues will be discussed in the article.

Types of hematuria

Based on the cause, hematuria (the symptoms of the pathology will be described below) is divided into:

  • extrarenal, not related to injury or kidney disease,
  • renal, developing due to renal pathology,
  • postrenal, which occurs if the urinary tract and bladder are affected.

If a sufficiently large amount of blood is detected in the urine and the urine itself acquires a reddish hue, then macromaturia takes place.

If red blood cells are present in the urine in a small amount and the color of the urine remains unchanged, they speak of microhematuria.

Based on which blood portion of the urine is present, initial hematuria (in the first portion), total (in all 3 portions), final (in the last portion) can be diagnosed. Such a division makes it possible to determine at what level of the urinary system the pathological process develops: the higher the lesion, the later red blood cells appear in the urine.

With isolated urinary syndrome, proteinuria and hematuria are often combined. Proteinuria is a condition characterized by the appearance of protein in the urine. An increased amount of protein in the urine is the most common sign of urological diseases.

Hematuria syndrome

This pathology may be accompanied by pain in the urethra and bladder when urinating or precede it. Sometimes the pain is permanent and relentless.

Pain in the lumbar region, in the side, under the scapula, may indicate inflammation of the kidney, injury, nephroptosis (descent of the kidney).

Common signs of blood loss are total hematuria, the symptoms in this case are pallor, weakness, thirst, dizziness.

Sand and stones may be emitted, indicating urolithiasis. In the case of the selection of cylinders (oblong clots) of yellow or brown color, it is possible to speak of a lesion (inflammatory or traumatic) of the renal parenchyma.

The skin of yellow, greenish hues indicate insufficient function of the gallbladder, liver, hemolysis, the destruction of red blood cells.

Acute or prolonged chronic bleeding in the urinary system, in which a large blood clot forms in a short time, blocking the entrance to the urethra, makes it impossible to empty the bladder. Also, the output of urine can be blocked by a large stone.

Why does this condition develop?

If hematuria is detected, the causes of this phenomenon may be different. The most common pathology in tumors, inflammatory diseases, injuries of the urinary tract, urolithiasis, glomerulonephritis, kidney tuberculosis, impaired blood clotting.

Normally, hematuria is extremely rare. A relatively benign condition in which microhematuria is diagnosed is a disease of the thin glomerular basement membranes. Most often, the relatives of these patients also identified cases of this disease. Microhematuria has an isolated character, and development of renal failure does not occur.

Microhematuria may occur after running or long walking. After the cessation of physical activity, red blood cells disappear. What is the reason for the development of such a phenomenon, today is not precisely established.

Gross hematuria is never detected in healthy people. This condition usually indicates severe damage to the urinary tract or kidney tissue.

Why can non-renal hematuria occur? The causes of this phenomenon are related to the violation of the integrity of the urinary tract mucosa. Preceding this damage are tumor, inflammatory lesions or injuries, which are often accompanied by ulceration. Hematuria of the bladder is the result of stone formation or passage of stone through the ureters, urethra, bladder. An overdose of anticoagulants can cause bleeding from the mucous membrane of the urinary tract.

Renal hematuria develops due to destructive processes in the tissues of the kidneys, impaired venous outflow, and necrotizing vasculitis. Glomerular hematuria is associated with immuno-inflammatory damage to the glomerular basement membrane or its congenital abnormalities. In addition, kidney hematuria occurs with inflammatory and toxic lesions of the tubules. Pathology can also develop due to enhanced renal intravascular coagulation.

So, hematuria - what is it and as a result develops? This condition may occur due to the pathology of the various parts of the urinary system.

  • Foreign body in the urethra.
  • Trauma to the urethra.
  • Tumor urethra. Cancer of the urethra is quite rare and is often accompanied by urethrorrhagia - the appearance of blood from the urethra between urination.
  • Inflammation of the urethra (urethritis).

Upper urinary tract:

  • Penetrating injury, dull injury.
  • Stones in the kidneys. Often the cause of hematuria is urolithiasis. Salt deposits form in the renal papilla, and as a result, stones form in the kidney drainage system. Kidney stones may not manifest themselves, but if irritation or inflammation of the urinary tract mucosa occurs in the urine.
  • Tumor kidney. An alarming sign of kidney cancer is worm-like blood clots in the urine. Blood may also appear due to benign tumors.
  • Infections.
  • Congenital disorders (cyst in the kidneys).
  • Blood clotting disorders (hemophilia, sickle cell anemia, leukemia).
  • Renal vein thrombosis, renal embolism.
  • Kidney diseases: glomerulonephritis (in this case, blood in the urine can only be detected with a microscope), pyelonephritis (with this ailment, blood in the urine may not be accompanied by a painful attack, but more often, fever, lower back pain, and infection of the blood are possible).

  • Injury.
  • Ascending infection.
  • The formation of stone in the ureter.
  • Tumor disease of the ureter.

Lower urinary tract:

  • Infections: hemorrhagic cystitis (severe illness, characterized by bleeding from the bladder), schistosomiasis (the bladder is affected by a parasite worm), bladder tuberculosis.
  • Bladder injury.
  • Urolithiasis disease.
  • Bladder tumor (it is very important to identify the painless appearance of hematuria, this will provide an opportunity to diagnose the early stage of the disease and conduct a successful treatment).
  • Irradiation of the bladder.
  • A drug like Cyclophosphamide, used to treat cancer, can trigger blood in the urine.

Diagnostics

Above, we have analyzed the symptoms and causes of such a phenomenon as hematuria, that this is what we know. Now let's discuss the methods of diagnosis of this pathology. In order to identify hematuria, it is required to conduct a urine test in the laboratory. Note that the color of urine does not always indicate the presence of blood. Urine can become dirty pink or light red due to the use of certain foods.

Examination of daily urine volume

Urine for analysis begin to collect from the second morning urination and finish the next day with the first morning urination. During the day, the urine is collected in one container, then the resulting volume is fixed, mixed well, and a part (150 ml) is cast into a separate container. In the process of collecting urine should be hygiene. In order to better preserve the material, use a special preservative.

Additional research methods

Sediment microscopy is also performed to determine the number of red blood cells in the field of view. It is possible to determine whether the tubules and glomeruli are affected using phase-contrast microscopy of urine sediment.

Differential diagnosis involves an ultrasound of the pelvic organs and kidneys, cystoscopy with biopsy, extro-urography, retrograde renography, kidney biopsy, testicular and prostate examinations, urine culture on a nutrient medium (determination of bacterial infection), computed tomography and X-rays (foreign body detection).

Hematuria: treatment of pathology

Hematuria is a symptom, so the treatment of this phenomenon should be carried out in conjunction with the treatment of the main disease.

To relieve bleeding, apply the preparations Vikasol, Ditsinon, aminocaproic acid, calcium chloride solution 10%. If the blood loss is more than 500 ml, infusion therapy is required to fill the blood volume.

If a calculus is found in the ureter or urethra, the use of antispasmodics and thermal procedures are prescribed, which will facilitate its discharge. If the stone cannot come out on its own, perform an operative or cystoscopic extraction.

In case of kidney injuries with tissue rupture and hematoma formation, emergency surgical intervention is necessary.

In the case of a combination of hematuria and proteinuria, corticosteroids are prescribed.

If chronic hematuria is diagnosed, treatment involves the use of iron preparations and vitamins of group B.

If the pathology in a child

Hematuria in children is most often associated with kidney parenchyma. In infancy, a short time after birth, congenital defects manifest themselves: the presence of a cyst, spongy kidney, etc. The preventive examination of a child must include urinalysis.

Chronic kidney bleeding in a child can be triggered by a tuberculosis infection that occurs aggressively in early childhood. Due to hereditary diseases of the blood coagulation system, multiple hemorrhages and hematuria occur, in which case hematomas and telangiectasias accompany. The child may be injured when falling. If hematuria is present in blood relatives without damage to health, the baby does not exclude a benign familial hematuria, this phenomenon is associated with a feature of the structure of the kidney.

Parents should be extremely attentive. Anxiety of the child should alert them, so can manifest pain. You should also pay attention to high body temperature and urinary retention.

Hematuria in children can occur due to streptococcal infection, which affects the renal parenchyma. Viral disease of the upper respiratory tract provokes IgA nephropathy. Most often, the pathology is benign in nature, and the development of chronic renal failure does not occur. The malignant course of the disease is manifested by high blood pressure, proteinuria, gross hematuria.

Hematuria during pregnancy

Most often, hematuria in women in the period of carrying a child occurs in the 2-3rd trimester. The fetus is constantly growing, the ureters are clamped by the uterus - this negatively affects the kidney function. The consequence of stagnation of urine in the pelvis may be the formation of stones that damage the epithelium and cause bleeding. The likelihood of hematuria increases dramatically if, before the pregnancy, the woman suffered from inflammation of the kidneys or she has chronic renal failure. It is very important not to confuse uterine bleeding and bleeding from the urinary tract. As in the first case, a serious danger threatens both the mother and the fetus. During the carrying of the baby, the blood coagulation system is activated, and for its correction, special preparations are prescribed. Hematuria in women during pregnancy may be caused by taking anticoagulants, and in order to stop bleeding, it is enough to cancel them.

Conclusion

Urological diseases in the absence of adequate treatment can provoke cancer, various inflammatory diseases, and numerous complications. In some cases, the only symptom of urinary system pathology is hematuria. What it is, you learned from this article. Do not leave this phenomenon without attention, and if it is detected, immediately contact a doctor. Only in this way will you save your health, and in some cases your life. Take care of yourself!

Hematuria, what is it?

In medical practice, this term means the excess of the permissible concentration of red blood cells in the urine. Not being an independent disease, hematuria indicates a progressive pathology in the renal system and urinary canals.

Human urine reflects all diseases of the body, because the withdrawal of toxins of biological and chemical properties mainly occurs through the kidneys. An anomaly localized in the urinary system can cause dysfunction of the renal glomerular membrane and cause the penetration of red blood cells into the urine. As a result of this process, human urine is colored in all shades of red, the saturation of which will depend on the number of red blood cells and the location of the site of inflammation.

Causes of disease

The problem of hematuria can occur in every person - a man, a woman, a child, of any age category. When diagnosing microhematuria, pathology of the glomerular membrane is possible, often of a genetic nature. The disease develops in isolation, without affecting the renal system as a whole.

A diagnosis of gross hematuria indicates severe lesions in the urinary system or renal tissues. The cause of renal (total) hematuria is a destructive process in the renal tissue with blood flow dysfunction - an inflammatory and toxic damage to the glomerular membrane and tubules. Hematuria, which does not have renal origin, is a consequence of a tumor or inflammatory lesion in the urinary system and damage to the bladder as a result of stone formation and stones.

Most frequent

The most likely and common causes of hematuria are:

  • infection in the urinary canal and diseases arising from this. In women, pyelonephritis and cystitis are infected, in men, prostatitis and urethritis,
  • the presence of stones of different localization - in the kidney, bladder and urinary canal. Often traces of blood appear after renal colic,
  • injury to the bladder, kidney, urethra and ureter.

The rarest

Rarely diagnosed causes of hematuria are diseases:

  • kidney - tuberculosis, hydronephrosis and polycystic
  • bladder - endometriosis and infectious tuberculosis,
  • of blood - thrombocytopenia, sickle cell anemia and hemophilia
  • schistosomiasis (mainly abroad),
  • systemic and hemorrhagic vasculitis.

Dangerous to health

A high concentration of blood elements in the urine is caused by diseases that threaten human health. Hematuria as a result occurs when:

  • internal injuries and destructive processes in the renal tissues - cancers, tuberculosis, purulent inflammations, necrotic papillitis,
  • venous hypertension in the kidney,
  • toxic and inflammatory processes in the connective tissue - hemorrhagic fever, interstitial nephritis,
  • nodular periarteritis, lupus nephritis, hemolytic-uremic syndrome due to coagulation process,
  • glomerular membrane damage (immune, metabolic), due to the disease glomerulonephritis, diabetic glomerulosclerosis, renal amyloidosis,
  • congenital (hereditary) membrane dysfunction - Allport syndrome.

Medicines

Taking certain medications may cause an increase in the concentration of blood elements in the urine, from micro to gross hematuria. Visually noticeable redness of blood varies from pinkish to dark brown tones and is a consequence of the use of the following drugs:

  • aspirin (acetylsalicylic acid) - pinkish tint,
  • amidopyrine, antipyrine, santonina - a clear redness,
  • cresol, phenol, activated charcoal, bear ears medicinal herb - darkening to brown,
  • Naphthol, salol - maroon urine.

In addition, when conducting analyzes, there is a probability of laboratory error, which is also interpreted as pseudo-hematuria.

Simulation reasons

When diagnosing, one should take into account the probability of penetration of traces of blood into the urinary tract from other body systems other than renal. It is also possible entry from the outside. Данная патология именуется экстрауринальной гематурией и имеет следующие симуляционные причины:

  • blood enters the urine upon completion of urination, due to small injuries of the fingers, lips, scrotum,
  • urination occurs after bladder catheterization,
  • foreign body trauma to the urethral mucous membranes,
  • mixing urine with the urine of a patient with renal pathology.

In addition, extraurinary hematuria has causes of genital and rectal origin.

Genital

In women, the concentration of blood elements in the urine is often associated with the menstrual cycle, and testing during this period often reveals signs of blood. Along with this, the genital causes are:

  • bleeding processes in tumors in the uterus and vagina, atrophic colpitis,
  • formation of cystic-uterine fistula due to operative trauma,
  • state of pregnancy
  • postcoital contraceptive use.

Rectal

Rectal hematuria due to:

  • hemorrhoids and blood secretions from hemorrhoids,
  • anal fissure bleeding,
  • cancer in the rectum,
  • chronic proctosigmoiditis, with the formation of a fistula near the anus.

The symptomatology of pathology depends on the main factors provoking the appearance of red urine. In most cases, the disease proceeds with a strong pain syndrome:

  • cutting pain in the area of ​​the bladder and urethra at the moments of urination, in front of them, or steady. The nature of the pain syndrome carries information for the diagnosis,
  • back pain, in the side, extending under the scapula, may indicate post-traumatic inflammatory processes and kidney prolapse,

In addition to pain, other symptoms appear:

  • general malaise, dizziness, constant thirst - as common signs of blood loss, characterizing total hematuria,
  • the appearance in the urine of cylindrical clots of a yellowish or brown hue, is a sign of inflammatory or traumatic processes in the cellular component of the kidneys,
  • the presence of sand and small kidney stones (stones) indicates urolithiasis,
  • difficulty bladder emptying. Pathology occurs when rapidly developing internal bleeding, provoking the formation of sufficiently large parts of coagulated blood capable of blocking the urethra. A large pebble can also make it harder for urine to flow.

The process of hemolization of red blood cells provokes a change in skin color. It acquires a yellowish / earthy hue, indicating hemolytic anemia and a decrease in the functionality of the liver and gallbladder.

Diagnosing

The diagnosis of hematuria is based on the installation of the causes of its occurrence, the diagnosis of the underlying disease. Often, pathology is detected visually, but for proper diagnosis, special procedures and laboratory tests are required:

  • general urine analysis and "according to Nechiporenko"
  • cystoscopy,
  • urography
  • ultrasound procedure,
  • examination of the adjacent specialist (gynecologist, proctologist),

The physician should make a detailed history, asking the patient about all injuries, operations and other diseases. If necessary, additional studies are appointed.

To clarify the diagnosis and classification of hematuria, a “two-glass test” is used. Without interrupting the act, the patient urinates in two tanks. The initial portion should be approximately 1/3 of the total volume. Detection of blood in it indicates the initial hematuria with the localization of inflammation in the urinary channel.

When the blood concentration in the remaining portion is diagnosed terminal hematuria associated with the bladder and urethra. Identifying signs of blood in both vessels indicates total hematuria.

The treatment of a pathological symptom is based on the removal of the underlying cause. Depending on its characteristics, various treatment methods are used. For example, the presence of a stone in the urethra or ureter canal is likely to require the intervention of a surgeon. With small sizes, when you can count on the output of the stone without an operation, the method of heat treatment and antispasmodics are used to facilitate the process.

Emergency treatment measures are not required for short-term microhematuria, however, the diagnosis of gross hematuria will require urgent hospitalization.

Recommendations of official medicine

The patient in serious condition with severe pain for first aid requires the introduction of painkillers. According to the recommendations of official medicine, the use of hemostatic agents is prohibited until the diagnosis is established. The imposition of a bubble with ice on the lower abdomen is permissible. After diagnostic procedures, coagulants are introduced.

In case of severe bleeding with a diagnosis of traumatic hematuria, a method of introducing therapeutic solutions through the catheter directly into the bladder is recommended.

In the state of pregnancy in women, treatment is selected with the most gentle methods. Completely refuse treatment can not, because there is a real threat to the life of a woman and her fetus.

In case of total hematuria with tumor formations, complex treatment is recommended, including surgery, radiation and chemotherapy.

Treatment of the underlying disease does not exclude the treatment of the pathology itself and the mandatory compensation of its consequences. To reduce the force of bleeding in violation of the functionality of the kidneys is most often recommended the use of drugs:

  • Vikasol in the form of tablets or injections with infusion therapy in an amount of from 15 to 30 mg per day, well relieves pain,
  • Diet, an analogue of the previous drug, has a fast action,
  • Aminocaproic acid, by insertion through a catheter,
  • Feropelect, Sorbifer, Durules, as preparations with iron content.

In infectious lesions of bacterial genesis with signs of blood in the urine, Gentamicin is effective, with contraindications to the drug:

  • Ofloxacin 200 mg 2 times a day,
  • Norfloxacin 400 mg in the morning and evening
  • Ciprofloxacin 500 mg twice.

With low effectiveness of bacterial treatment with a diagnosis of pyelonephritis, it is necessary to re-examine.

In combination with drugs, it is recommended that the patient drink a full course of B vitamins.

Folk remedies

Treatment of pathology with the use of traditional medicine recipes is auxiliary, but in any case, it is agreed with the doctor. For kidney diseases, decoctions and infusions from pharmacy renal preparations are used, which are freely sold at any pharmacy.

To relieve inflammation in the urinary system, the root system of barberry, blackberry, iris is used:

  • brew crushed barberry root with 250 ml of boiling water and stir for 15 - 20 minutes. Take 50 g to 3 times a day,
  • 1 tbsp. A spoonful of crushed blackberry rhizomes Pour red wine in the amount of 150 ml and protomit on low heat for 5 - 10 minutes. Take 30 - 40 g 2 - 3 times a day.

With minor patches of blood and the absence of severe pain, use the following means and methods of traditional medicine:

  • every day in the morning on an empty stomach to drink a fresh egg (preferably from a domestic chicken),
  • daily for 10 days, drink freshly squeezed juice from the stems and leaves of the shepherd's bag. Squeeze the crushed grass through cheesecloth and mix with 1x1 honey. Take a tablespoon every 2 - 3 hours,
  • 2 tbsp. spoons of bearberry herb brew 250 ml of boiling water and protomit 15 - 20 minutes, let it brew until it cools, strain and take half a cup 3 times a day.

To aid in dissolving or crushing stones, herbs with more aggressive properties are used, but their use must be controlled by a specialist, and besides, these decoctions can spoil tooth enamel.

Preventive measures

The most common cause of pathology is a bacterial infection of the urinary tract when personal hygiene and a healthy lifestyle are not followed. For the prevention of hematuria should be:

  • be wary of using public toilets, baths - to prevent infection with genital / bacterial infections,
  • women - to change personal care products in a timely manner,
  • choose sets of underwear from natural fabrics,
  • if possible, do not overcool the body and promptly treat viral infections,
  • avoid excessive physical exertion.

The use of harmful foods and drinks containing a large amount of chemical compounds is not recommended in order to avoid general intoxication of the body. Chances of detecting signs of blood in the urine will be significantly reduced if a person gives up bad habits. For example - smoking tobacco, contributing to the development of urinary tract cancer.

It should not be forgotten that hematuria is not an independent disease and preventive measures should be aimed at preventing urological diseases of the renal system as a whole.

Concomitant hematuria symptoms

Hematuria can be combined with pain in the urethra and bladder of a permanent nature, during or in front of urination.

The pain can also be localized in the lumbar region, in the side, under the scapula. It speaks of inflammation, trauma, kidney prolapse.

Total intensive hematuria is accompanied by weakness, pale skin, thirst, dizziness - these are signs of blood loss.

If hematuria is observed the release of calculus or sand, this indicates the presence of urolithiasis, oblong light yellow or brown clots (cylinders) - inflammation or injury of the renal parenchyma.

Greenish or yellow color of the sclera and skin suggests that the cause of hematuria is insufficient function of the gallbladder or liver.

Glomerular hematuria Edit

When glomerular hematuria, red blood cells, passing through the basement membrane of the glomerular capillaries, are deformed (damaged). Microscopically, such erythrocytes are recognized by their altered shape, smaller than normal erythrocytes in a volume that varies in size. They are devoid of hemoglobin and look like faint colorless rings. Red blood cells modified in this way are called "leached" or also "red blood cell shadows."

Postglomerular hematuria Edit

With postglomerular hematuria, the erythrocyte morphological changes are not detected, since the source of bleeding is located after the glomerular filter and the erythrocytes do not have to squeeze through the cracks in the basement membrane to enter the urine.

Common causes of gross hematuria include:

  • glomerulonephritis,
  • some urinary tract infections [1] caused by uropathogenic species E. Coli (UPEC) as well Staphylococcus saprophyticus,
  • kidney stones [2] (or bladder stones),
  • bladder swelling [3]
  • renal cell carcinoma [4] - sometimes accompanied by bleeding,
  • prostate tumor [5],
  • prostate stones [6]
  • coagulation disorders, in particular, hemophilia,
  • benign familial hematuria,
  • genitourinary schistosomiasis (caused by Schistosoma haematobium) - the main cause of hematuria in Africa and Central Asia,
  • IgA-nephropathy (Berger disease) - occurs when viral infections in predisposed individuals
  • nighttime paroxysmal hemoglobinuria is a rare disease in which hemoglobin from red blood cells undergoing hemolysis passes into the urine,
  • blood from the genitals of women (with menstruation or gynecological diseases),
  • damage to the urinary catheter,
  • arteriovenous kidney malformations,
  • dysmetabolic nephropathy.

There are macro-and microscopic hematuria. Macroscopic is divided into three types: initial, or initial, final, or terminal, and full, or total. Initial hematuria is a consequence of bleeding from the urethra, often from the anterior.

Hematuria should be distinguished from urethorrhagia, in which blood from the urethra is released outside the act of urination.

Initial hematuria is observed in urethral tumors, in case of injury of the urethra, after instrumental examination, when the urethra is accidentally damaged.

In terminal hematuria, the source of bleeding is often localized in the bladder or in the posterior urethra. Stones, tumors, bladder ulcers are the cause of terminal hematuria.

With total hematuria, the source of bleeding is often localized in the kidneys, sometimes it can be profuse and urine becomes dark red (the color of cherry jam) with blood clots.

Diagnostic value has the form of clots. So, if there are lumps of the “worm” type in the urine, then a kidney tumor may be a source of bleeding, and the presence of shapeless lumps is characteristic of a bladder tumor.

Total hematuria can be observed with urolithiasis, but it is more often microscopic, less often macroscopic. Hematuria due to urolithiasis is often detected after an attack of pain.

Total hematuria is associated with many inflammatory diseases of the parenchyma and upper urinary tract (pyelonephritis, necropapillitis, etc.).

To establish the source of bleeding with gross hematuria, it is always necessary to perform cystoscopy. The opinion among some doctors that with hematuria, especially profuse, one should refrain from cystoscopy, does not hold water. On the contrary, in such cases it is especially indicated, since there are situations in which emergency surgery is necessary and only after cystoscopy are the side and source of bleeding determined.

Pseudo-hematuria or false hematuria - urine redness due to the intake of certain drugs or foods. It can be caused if you eat food with pulp of red color in too large quantities. [ source not specified 505 days ]

Hematuria with glomerulonephritis

Glomerulonephritis causes damage to the main structure of the kidneys - the nephron. The vascular glomerulus is responsible for filtering the substances to be eliminated. As a result of the pathological process, the glomerular vessels become permeable and passable for the penetration of red blood cells. So, in the urine and blood appears.

Microscopic examination of urine sediment can be seen deformed, leached red blood cells. Glomerulonephritis is characterized by gross hematuria. Urine in appearance resembles meat pomo. In the urine protein is detected. Patients are diagnosed with arterial hypertension.

Hematuria in women

Cystitis is perhaps the most common cause of hematuria in women. Due to anatomical features, inflammation of the bladder often occurs in women.

Combined oral contraceptives can also cause blood. Hormonal substances in their composition, weaken the tone of the urinary tract walls, which leads to inflammatory reactions and stagnant processes.

In pregnant women, the cause may be hormonal changes, the mechanical effects of the growing uterus, and the rupture of small vessels.

Hematuria in men

In men, in most cases, hematuria is benign. The appearance of blood in the urine may be the result of intense physical exertion. Increased renal blood flow, hypertension, exposure to metabolites - all this and much more can provoke a pathological condition. If hematuria is the result of prolonged overload, then after a good rest, it disappears without a trace.

Cancer is a common cause of hematuria in men. So in twenty percent of cases, gross hematuria is the result of a neoplasm. In addition, male hematuria is closely associated with diseases of the prostate gland.

If the doctor has determined that the symptom is directly related to intense training, then the man will be advised to switch to a less intensive exercise program. Proper lifestyle reduces the likelihood of hematuria. This includes giving up bad habits, namely smoking and alcohol abuse, as well as sufficient use of natural water.

Hematuria in children

In addition to the above reasons, in childhood hematuria may be due to certain blood disorders and hemorrhagic diathesis. Changes in the properties of the blood and the state of the vascular walls can cause hematuria.

Uric acid diathesis is another reason for the appearance of blood in children. The basis of this disease is damage to the renal structures of salt crystals. In addition, hematuria in children often appears after a viral infection, especially if nonsteroidal anti-inflammatory drugs are used in treatment.

Prevention

If you want to prevent hematuria, follow these guidelines:

  • Try not to overcool, do not sit in the cold and dress for the weather,
  • observe the correct diet,
  • drink enough natural water
  • avoid excessive loads and injuries
  • timely empty the bladder,
  • If you experience anxiety symptoms, consult a specialist.

Types of hematuria disorders

Hematuria is the first wake-up call for the occurrence of certain pathologies that trigger the excretion of urine.

Depending on how the pathology manifests itself, the following are distinguished:

Blood when urinating

  • gross hematuria. Red blood cells are found in large numbers and accumulate in the urinary system.The color of urine in this disorder varies from pinkish to brownish dark, sometimes blood clots flow out,
  • microhematuria. In this case, the urine erythrocyte count is so small that it manifests itself only when passing urine analysis in laboratories, and microhematuria is found only in this way.

Violations are of three types:

  • type of initial hematuria,
  • type of terminal hematuria,
  • view of total hematuria.

Terminal hematuria is manifested by the fact that the blood is only at the release of the last portion of urine. Caused by diseases of the cervical urethra and inflammation of the prostate gland.

Symptoms classification for hematuria

When an act of urine emission occurs, certain types of hematuria are released:

Severity of the disease

  • initial views. The symptom manifests itself as a blood clot or slight diffuse blotch is present when the first portions of urine are excreted,
  • end species. Plasma is manifested in the final stage of the emission of urine, its finishing part,
  • total species Plasma is distributed throughout the portion of urea (this phenomenon is the most dangerous).

These types are the most important points that can not be released from sight, when the attending physician diagnostics determines the result of the analysis.

Symptoms of hematuria

Pathology in the form of hematuria often manifests itself as:

Weakness and dizziness

  • urination is broken,
  • changing urine color,
  • decreases the thickness of the urinary flow,
  • pains in the side of the abdomen (right or left),
  • feverish beating,
  • worm-like blood clots,
  • pain sensations subscapularis and lower back,
  • general weakness
  • dizziness,
  • constant thirst for water
  • pale skin
  • shades of skin and eyes yellowish or greenish,
  • inability to empty urine.

Why blood is formed in urine

It is necessary to establish the answer to the question - if this symptom manifests itself, then what is hematuria which causes?

The causes of plasma in urine can be the following pathologies:

Causes of blood in the urine

  • urinary tract diseases
  • genitourinary trauma caused by any factors, including frequent indiscriminate sex,
  • endometriosis,
  • varicose formations
  • hemorrhagic diathesis,
  • inflammation of the cecum (appendicitis),
  • papillomas and warts,
  • hemophilia,
  • scurvy,
  • physical loads
  • thrombocytopenic purpura,
  • infection of the excretory systems
  • radiation therapy,
  • impaired blood flow in the body
  • collagenosis
  • tuberculosis or purulent discharge,
  • inflammation of the prostate gland
  • vascular pathologies,
  • plasma admixture of the vagina or penis, as well as intestinal bleeding.

Causes of non-renal hematuria

Ureters Bladder

Urinary tract
Prostate adenocarcinoma Benign prostatic hyperplasia

Infections and parasitic invasions

Acute cystitis, prostatitis, urethritis caused by bacteria or Chlamydia trachomatis
Tuberculosis, urinary tract schistosomiasis

Cyclophosphamide (hemorrhagic cystitis)

Urinary tract foreign body
Urinary tract contusions
Long walk / run

Causes of glomerular hematuria

Primary lesions of the glomeruli of the kidneys

Secondary lesions (with systemic diseases)

Acute postinfectious glomerulonephritis

Nephropathy with minimal changes

Systemic lupus erythematosus

Systemic vasculitis (especially ANCA-associated)

Subacute infective endocarditis

Essential and HCV-associated mixed cryoglobulinemia

Thrombotic thrombocytopenic purpura (TTP)

Disease of the thin basement membranes of the renal glomeruli (“benign” familial hematuria)

Causes of non-shallow hematuria

Wilms tumor (nephroblastoma)

Angiomyolipoma (tuberous sclerosis)

Renal vein thrombosis

Malignant arterial hypertension

Necrosis of the renal papillae

Acute Medicinal Tubulo-Interstitial Nephritis

Cystic kidney disease

Autosomal dominant polycystic kidney disease

Medullary cystic disease / familial juvenile nephronophthiasis

Medullary spongy kidney

Contusion or crush of the kidney

In all variants of hematuria, it is necessary to search for its causes. In patients with already diagnosed chronic kidney and / or urinary tract diseases, hematuria, especially gross hematuria, always indicates an increase in activity or an exacerbation of the disease.

Pathogenetic factors of hematuria

The sudden appearance of an unusual, blood-like urine stain, sometimes among full health, in the absence of any other painful manifestations, certainly frightens the patient, prompting him to seek emergency help. However, not always visually intense coloring of urine with blood indicates massive bleeding. Arterial bleeding from the kidney and urinary tract without prior injury or surgery is an exception. Most hemorrhages that manifest hematuria are usually venous. Most often they arise from the fornical plexus, surrounding the arches of the calyx of the kidney or varicose submucous veins of the pyeo-pelvic system, ureters, bladder or urethra.

Intensive bleeding is indicated by the presence of clots in the urine stained with blood, in especially severe cases their formation in the eyes of the patient and the doctor immediately after urination is a sign of massive bleeding that threatens the patient's life. When hematuria due to urological disease, proteinuria occurs, which, as a rule, is of a false character and is primarily associated with the presence of hemoglobin in the urine, as well as plasma proteins. The false proteinuria level of 0.015 g and more against the background of gross hematuria characterizes severe, life-threatening bleeding and requires urgent diagnostic and therapeutic measures.

In cases of massive bleeding from the kidney and upper urinary tract in trauma and neoplasms, as well as a tumor of the bladder and prostate gland, the bladder can overflow with urine with large amounts of blood and clots that obtrude the neck of the bladder and the internal opening of the urethra, and the muscular wall elements prohibitively overstretched, making the reduction of the detrusor and the opening of the neck impossible. There is an acute urinary retention due to tamponade of the bladder. Such patients need emergency urological intervention.

Symptoms of hematuria

Hematuria, along with edema and severe arterial hypertension, is considered as an essential component of acute-nephritic syndrome. It is characteristic of acute glomerulonephritis, including post-streptococcal, or indicates an increase in the activity of chronic glomerulonephritis. For hemorrhagic syndrome, gross hematuria is more characteristic.

Acute nephritis syndrome in acute glomerulonephritis is sometimes combined with signs of acute renal failure - an increase in the concentration of serum creatinine and oligo- or anuria. Hypervolemia causes the severity of arterial hypertension. Dilatation of predominantly left heart regions with signs of stagnation in the pulmonary circulation is often rapidly developing. Acute nephritis syndrome in acute glomerulonephritis in most cases is completely reversible, immunosuppressive therapy, as a rule, is not required.

A significant increase in urinary protein excretion is not characteristic of acute post-streptococcal glomerulonephritis and, rather, indicates an exacerbation of chronic glomerulonephritis. The disappearance of gross hematuria in patients with chronic glomerulonephritis indicates the achievement of remission, although microhematuria can persist for a very long time. The presence of hematuria in chronic glomerulonephritis always indicates the activity of kidney damage.

Hematuria is observed in various variants of chronic glomerulonephritis (IgA-nephropathy), including in the framework of systemic diseases (Schönlein-Genoch purpura). The combination of hematuria with deafness and the presence of kidney disease in history indicates Alport syndrome (hereditary nephritis with deafness).

The frequency of hematuria in different variants of chronic glomeruloneitis in adults and children is not the same. Microhematuria is observed in 15–20% of children suffering from nephropathy with minimal changes, and the nephrotic syndrome in them is usually sensitive to treatment with corticosteroids. In adult patients with nephropathy with minimal changes, microhematuria is observed much less frequently.

Microhematuria is a characteristic sign of tubulointerstitial nephropathy, including the exchangeable nature (hypercalciuria, hyperuricosuria). This symptom may exist for a long time in isolation or be combined with a moderate decrease in the relative density of urine.

Hematuria and rapidly increasing renal failure, accompanied by bloody diarrhea, are characteristic of hemolytic-uremic syndrome. In addition, hemolytic anemia and clinical signs of hypohydration are found in these patients.

Hematuria is also caused by urinary tract infections and nephrolithiasis. In elderly patients with isolated microhematuria, especially in combination with fever or subfebrile conditions, urinary tract tumors, including kidney cancer, should be excluded.

Asymptomatic total hematuria with intense urine staining, accompanied by the release of clots is a very serious symptom of kidney and bladder tumors. Often, hematuria is absent for a long time or is intermittent. This should not reassure the doctor or the patient. It is necessary to conduct a full range of special studies confirming or excluding diseases that caused hematuria. If the results of ultrasound and other objective methods do not provide information about the cause of hematuria, then a cystoscopic examination should be performed at the height of hematuria to establish the source of bleeding. In addition to examining the cavity of the bladder, it is necessary to find out the nature and color of urine secreted from the mouths of both ureters. This simple technique will allow to establish not only the degree of hematuria, but also its single or bilateral origin.

Various clinical symptoms should be analyzed. The combination of several signs, the timing of their occurrence allows the doctor with a high probability to make an assumption about the possible etiology of hematuria. The definition of topical diagnosis contributes to the analysis of the interdependence of the occurrence of pain and hematuria. In urolithiasis, pain always precedes the latter, and the intensity of bleeding is most often low. At the same time, with intensive hematuria with clots, caused by the destructive process, pain occurs after it due to the violation of the outflow of urine by the resulting blood clot. Painful frequent urination with concomitant hematuria indicates a pathological process (swelling, stone, inflammation) in the bladder.

With stones in the bladder, hematuria occurs after intense walking, jolting in transport and is accompanied by frequent urination. Often, pain radiates to the head of the penis.

Hematuria is a very important symptom of urological diseases. Any patient who has hematuria at least once (if it is not associated with acute cystitis) needs urgent urological examination.

With asymptomatic hematuria, if there is no absolute confidence in the localization of the pathological process, it is advisable to perform cystoscopy. It should be remembered that the wrong tactics of the doctor in hematuria can cause late diagnosis of the tumor process.

Examination and physical examination

The connection of hematuria with chronic glomerulonephritis is confirmed by arterial hypertension, edema. The presence of a skin rash (primarily purpura), arthritis indicates kidney damage within the framework of systemic diseases.

Affordable palpation and an enlarged kidney are observed in its tumor lesion.

Laboratory diagnosis of hematuria

Hematuria, hemoglobinuria, and myoglobinuria are distinguished by special tests. The most commonly used sample is ammonium sulphate: 2.8 g of ammonium sulphate is added to 5 ml of urine. The hemoglobin precipitates and after filtration or centrifugation settles on the filter, the myoglobin is preserved in dissolved form, and the urine remains colored.

Test strips that detect hemoglobin peroxidase activity are used as screening: red blood cells are hemolyzed on indicator paper, and hemoglobin, causing oxidation of the organic peroxide applied on the test strip, changes its color. If there is a large amount of peroxides or massive bacteriuria in the urine, a false positive reaction is possible.

The presence of hematuria should be confirmed by microscopy of the urinary sediment.

Detect unchanged and altered red blood cells contained in the urine. Unchanged red blood cells are round, nuclear-free cells of yellow-orange color. Altered erythrocytes have the form of single or double-circuit bodies (shadows of erythrocytes), usually almost colorless, or discs with jagged edges.

Detection of acanthocytes in the urine — erythrocytes with an uneven surface resembling a maple leaf — is considered one of the reliable signs of glomerular hematuria.

Quantitative methods are also used to determine microhematuria. One of the most frequently used is the Nechiporenko method, which is based on counting the number of corpuscles (erythrocytes, leukocytes, cylinders) in 1 ml of urine; normally, the content of erythrocytes in 1 ml of urine does not exceed 2000.

Laboratory diagnosis allows to confirm predominantly renal origin of hematuria.

Laboratory research methods used in the differential diagnosis of hematuria

General urine analysis

Blood chemistry

Immunological blood test

Crystals (urates, oxalates)

Increased alkaline phosphatase activity

Increased IgA

Antibodies to the glomerular basement membrane

Antibodies to cardiolipin

Markers of HBV-, HCV infections

Instrumental diagnosis of hematuria

Diagnostics of hematuria uses instrumental, including visualizing research methods:

  • ultrasound examination of the abdomen and kidneys,
  • ultrasound examination of the bladder and prostate gland,
  • computed tomography of the abdominal cavity and small pelvis,
  • MRI,
  • excretory urography
  • cystoscopy.

The combination of hematuria with significant proteinuria and / or progressive impairment of kidney function is considered as an indication for a kidney biopsy.

Renal hematuria is divided into glomerular and non-glomerular. To distinguish between these variants, phase contrast microscopy is used.

With microhematuria, light microscopy of urine sediment allows detection of both fresh and leached erythrocytes, which are an indirect sign of minor bleeding from the kidney and upper urinary tract. The phase-contrast microscopy method proposed in the Therapy and Occupational Diseases Clinic of the Moscow Medical Academy named after M.A. THEM. Sechenov.

Functional exercise test with a combination of microhematuria and proteinuria also helps in the diagnostic search. The increase in the amount of protein and unchanged erythrocytes on the background of physical exertion is more characteristic of urological causes of microhematuria (small calculus, “fornical” bleeding). The increase in the amount of protein with a sharp increase in the number of altered erythrocytes is an indirect sign of impaired outflow of venous blood from the kidney, while a sharp increase in proteinuria with a slight increase in the titer of formed elements in the sediment is more characteristic of nephrological patients.

Detailed consideration of the causes of hematuria is due to diagnostic and tactical errors that can be observed in the outpatient and clinical practice of the nephrologist. The most tragic are situations related to the late diagnosis of oncological diseases - tumors of the renal parenchyma, the cup-pelvis-plating system and the ureter, bladder, etc. Of particular relevance is a rational diagnostic and treatment tactic for suddenly arising total painless gross hematuria. It should be considered as an emergency, requiring urgent diagnostic and therapeutic measures that should be carried out by a urologist.

In the presence of clinical data for acute inflammatory process (acute cystitis in women, acute urethritis and prostatitis in men) the cause of hematuria can be understood already on the basis of clinical data. In other cases, on an emergency basis, you need to conduct a 2-glass test, which will help confirm the presence of gross hematuria at the time of the inspection, roughly (by eye) assess its intensity, the presence and form of blood clots. Worm-shaped clots indicate bleeding from the kidney and upper urinary tract, formless, most likely formed in the bladder. Visual assessment of the received 2 servings of urine allows to clarify the nature of hematuria (initial, total or terminal).Subsequent emergency laboratory research will allow differentiating hematuria from hemoglobinuria and estimate the bleeding intensity approximately from the level of false protein and the number of formed elements. Initial gross hematuria requires emergency urethroscopy and urethrography, and other types require ultrasound and urethrocystoscopy in order to clarify the source of the bleeding. In urethrocystoscopy, it may be the affected urethra and bladder, the mouth of the right or left ureter, or both ureteral orifices.

Bilateral excretion of urine stained with blood is more characteristic of disorders of the blood coagulation system and diffuse inflammatory diseases of the kidneys. Urological diseases, as a rule, are manifested by unilateral bleeding. To reliably establish the source of bleeding, it is necessary to identify a consistently repetitive rhythmic flow of urine portions, markedly stained with blood from the corresponding ureteral orifice or having a characteristic visual pattern of the pathological process on the mucous membrane of the bladder (tumor, inflammation, ulcer, calculus, varicose veins, etc.). It is necessary to emphasize that for greater reliability and prevention of subjectivity in the evaluation of the cystoscopic picture, at least two doctors should participate in such an emergency study, and with the appropriate technical means, it is desirable to perform video recording.

Modern research opportunities (if necessary against the background of medical polyuria) using not only abdominal, but also rectal and vaginal sensors make ultrasound examination especially shown, necessary and informative, nevertheless, the pathological process in the kidney and bladder or should not be the reason for the refusal of an emergency cystoscopic examination in case of acute total gross hematuria, as the patient may suffer not one, but two or more diseases. Thus, in a kidney tumor, a bladder tumor is possible, and in prostatic hyperplasia, in addition to a bladder tumor, pathological processes can occur in the kidney and upper urinary tract, etc.

Appearing suddenly, hematuria may be short-lived and stop on its own. The absence of any noticeable clinical manifestations (pain, dysuria) can calm the patient and the doctor, convince them that there is no need for a detailed examination. The next episode of hematuria, the appearance of other symptoms of the disease as it progresses, may indicate a late diagnosis, in this case the prognosis is much worse.

Tactics of in-depth examination to clarify the cause of hematuria depends on a comprehensive assessment of clinical symptoms, data from physical, laboratory, ultrasound, endoscopic and other studies. The principles of such a survey should be the selection of optimal methods for obtaining the maximum information necessary to establish a correct diagnosis and determine rational therapy, prevent unjustified treatment for inadequate or erroneous diagnostics, and use the entire necessary arsenal of diagnostic tools, especially for detecting or excluding surgical diseases.

Differential diagnosis of renal hematuria using phase-contrast microscopy

Male hematuria

In men, plasma in urine occurs for a number of additional reasons:

Pain in the groin

  • oncological tumors in the prostate gland,
  • inflammatory processes in organs producing seed,
  • congenital renal pathology,
  • impaired plasma clotting,
  • necrosis of the papillary system
  • pathology in vessels
  • purulent inflammation,
  • heavy loads on the body by the method of physical tension.

Female hematuria

Vaginal bleeding in women have their own reasons, we highlight the main ones:

Pain in lower abdomen

  • neglecting the care of the anus,
  • prolonged use of tight underwear,
  • pathologies associated with cystitis,
  • gynecological pathology,
  • surgical interventions in the uterine part and vagina,
  • urethritis
  • the occurrence of pregnancy and the postpartum state,
  • urinary infection,
  • urethral trauma subsequently wearing catheters, cystoscopic intervention,
  • consequence of taking anticoagulant drugs.

Pediatric hematuria

Small children, unfortunately, are also prone to this pathology.

The causes of bloody discharge from children's genital organs are the following:

Kidney problems in children

  • impaired renal excretion
  • nephrotic syndromes,
  • urinary tract infection,
  • obstruction of the urinary duct,
  • vascular pathology,
  • gallbladder reflux,
  • swelling,
  • trauma to the external genital organ
  • the presence of a foreign body in the urethra,
  • exchange nephropathy,
  • thrombopathy,
  • vasculitis,
  • hereditary nephritis,
  • glomerulonephritis,
  • the presence of cysts of different sizes
  • inflammation of the urethra or prostate glands,
  • use of dangerous medimentoznyh drugs.

Infants and young children get a manifestation of the disease, irregular temperature, or pain in the lower abdomen. Pain in the abdomen appears when there are stone tumors of the kidneys or urinary ducts. Hematuria is also received by children with constant infectious accompaniment, congenital impairment of the urinary tract, or the failure of the body's metabolic process, which provokes the formation of stones.

Plasma in the urethra of pregnant women

Spotting during pregnancy is detected by the doctor for any timing. The disease causes anxiety in both the patient and her attending health care professional. Plasma excretions from the urethra in pregnant women should not cause particular concern, but just in case a woman is obliged to be examined. Most often, the plasma in the urine in patients "with hope" is idiopathic, that is, it appears for no reason.

In pregnant women, hematuria is something that subsequently the childbirth itself should disappear, then you can not worry about the possible pathologies of the body. Extremely rare situations are such when hematuria is repeated during the postpartum period, but then it is a factor denoting pathology in the renal system and the urethra.

Women in the position of getting hematuric syndromes for the following reasons:

  • stone formation,
  • inflammatory processes of the renal system or renal failure,
  • anticoagulants affecting the urinary tract,
  • hormonal change,
  • mechanical effects of fetuses on the renal system and urethra,
  • ruptures of venous tissue around the circumference of the renal cups.

Whatever the outcome of the diagnosis, it is necessary to take all measures to establish and eliminate the cause of the pathology, for such conditions are dangerous for both the woman and her unborn baby.

How to cure hematuria?

As soon as a person identifies negative symptoms, he is obliged to immediately consult a health worker, because timely therapy is the key to a healthy and happy existence. Therapy of the manifestations of disorders will give impetus to the cure of diseases that were accompanied by hematuria, and which became its pathogens.

What means hematuria is treated?

First of all, it is an antibiotic treatment. It is used for the treatment of bacterial infections. It is also possible to use shock-wave lithotripsy, which can crush kidney stones, and in the future they will independently emerge through the urethra.

In the most unpredictable and neglected cases, surgical intervention is prescribed. In this case, the operation depends on the complexity of the diagnoses. And, as the most productive option, used combination methods of treatment of the disease. It consists of the possibility of a surgical intervention, radiation therapeutic methods, or, in difficult cases, chemotherapy.

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