Hematuria: Wikis

  

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Hematuria
Classification and external resources

Microscopic hematuria
ICD-10 N02., R31.
ICD-9 599.7, 791.2
DiseasesDB 19635
eMedicine ped/951
MeSH D006417

In medicine, hematuria, or haematuria, is the presence of red blood cells (erythrocytes) in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract (kidneys, ureters, urinary bladder, prostate, and urethra), ranging from trivial to lethal. If white blood cells are found in addition to red blood cells, then it is a signal of urinary tract infection.

Occasionally "hemoglobinuria" is used synonymously, although more precisely it refers only to hemoglobin in the urine.

Contents

Types

Red discolouration of the urine can have various causes:

Analysis

Hematuria seen directly in a urine sample.

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 more precise.

In older patients, cystoscopy with biopsy of suspected lesions is often employed to investigate for bladder cancer.

If combined with pain, it may be loin pain hematuria syndrome.[1]

Per AUA (American Urologic Association) guidelines [2], the following should be performed for high risk patients with significant microhematuria (greater than 3 red blood cells per high powered field):

1) Upper tract imaging of which a CT urogram is the gold standard

2) Urine cytology

3) Cystoscopy

Causes

The most common reason for hematuria in a man 50 years of age or older is Benign prostatic hyperplasia (BPH; enlarged prostate).[3]

The most common causes in people younger than 40 years are kidney stones or ureter stones.[4]

The most common causes of hematuria/haematuria are:

Viral infections of the urinary tract and , particularly in women

  • Kidney diseases[5]

Other possible causes of hematuria include:

  • 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)
  • Nephritic syndrome (a condition associated with post-streptococcal and rapidly progressing glomerulonephritis).
  • Fibrinoid necrosis of the Glomeruli (as a result of malignant hypertension)
  • Bladder vescile varices may rarely develop secondary to obstruction of the inferior vena cava.[6]
  • Allergy may rarely cause episodic gross hematuria in children.[7]
  • Left renal vein hypertension, also called "nutcracker phenomenon" or "nutcracker syndrome," is a rare vascular abnormality responsible for gross hematuria.[8]
  • Ureteral Pelvic Junction Obstruction (UPJ) is a rare condition beginning from birth in which the ureter is blocked between the kidney and bladder. This condition may cause blood in the urine.[9]
  • March hematuria - Very prolonged exercise, such as long-distance horseback riding and bicycle riding.[10]

References

  1. ^ Spetie, DN.; Nadasdy, T.; Nadasdy, G.; Agarwal, G.; Mauer, M.; Agarwal, AK.; Khabiri, H.; Nagaraja, HN. et al. (Mar 2006). "Proposed pathogenesis of idiopathic loin pain-hematuria syndrome.". Am J Kidney Dis 47 (3): 419-27. doi:10.1053/j.ajkd.2005.11.029. PMID 16490620.  
  2. ^ http://www.aafp.org/afp/20010315/1145.html
  3. ^ Digital Urology Journal > HEMATURIA Information provided by GU Logic (800) 451-8107. Retrieved on Dec 19, 2009
  4. ^ Blood in Urine: Causes & Treatment by MariAnne, senior nurse. Aug 22, 2006
  5. ^ a b c d e f Hematuria Causes Original Date of Publication: 15 Jun 1998. Reviewed by: Stacy J. Childs, M.D., Stanley J. Swierzewski, III, M.D. Last Reviewed: 10 Jul 2008
  6. ^ Koshy, CG.; Govil, S.; Shyamkumar, NK.; Devasia, A. (Jan 2009). "Bladder varices--rare cause of painless hematuria in idiopathic retroperitoneal fibrosis.". Urology 73 (1): 58-9. doi:10.1016/j.urology.2008.06.039. PMID 18722652.  
  7. ^ Graham, DM.; McMorris, MS.; Flynn, JT. (Nov 2002). "Episodic gross hematuria in association with allergy symptoms in a child.". Clin Nephrol 58 (5): 389-92. PMID 12425491.  
  8. ^ Russo, D.; Minutolo, R.; Iaccarino, V.; Andreucci, M.; Capuano, A.; Savino, FA. (Sep 1998). "Gross hematuria of uncommon origin: the nutcracker syndrome.". Am J Kidney Dis 32 (3): E3. PMID 10074588.  
  9. ^ Ureteral Pelvic Junction Obstruction (UPJ) / Ureteral Obstruction
  10. ^ William Williams Keen, John Chalmers Da Costa, ed (1908). Surgery, Its Principles and Practice. 4. W. B. Saunders Company. http://books.google.com/books?id=QnYwAAAAIAAJ.   page 239







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