Hematuria is a laboratory symptom characterized by the presence of red blood cells in the urine. The causes may be inflammatory diseases of the kidneys, urolithiasis, malignant neoplasms. Depending on the degree of hematuria, the color of urine can change to red, brown, "the color of meat slops", but in the vast majority of cases it remains unchanged. More than 3-5 erythrocytes in the field of view during microscopy of the urine sediment or more than 1000 in 1 ml when performing the Nechiporenko test is considered to be exceeding the norm. To correct this laboratory phenomenon, the underlying disease is treated.
By nature, the following types of hematuria are distinguished:
According to the degree of expression, they distinguish:
By origin, hematuria is divided into:
When examining the physicochemical properties of urine using test strips, it is possible to obtain false results for blood:
Kidney stones are a common cause of hematuria
The main reason for the appearance of blood in the urine in children. With glomerulonephritis, erythrocytes enter the urine through the wall of the capillaries of the glomeruli of the kidneys damaged by the inflammatory process. When passing through the glomerular capillaries, blood cells are deformed, which is considered a characteristic feature in urine microscopy. In chronic glomerulonephritis, moderate or slight hematuria is noted.
With an exacerbation of inflammation, the number of erythrocytes in the urine is very high, up to gross hematuria with a change in the color of urine. Often there is a combination with leukocyturia and proteinuria. After specific therapy, hematuria quickly disappears. Glomerular pathologies include:
Hematuria is observed in approximately 30% of patients with acute or exacerbation of chronic pyelonephritis. The inflammatory process in the renal pelvis leads to the entry of blood into the renal tubules. However, the number of erythrocytes is insignificant or moderate (up to 15-20). Hematuria is always accompanied by leukocyturia, bacteriuria, a positive test for nitrites. After antibiotic therapy, blood, as a rule, is not detected in the urine.
The destruction of the renal tissue of a necrotic nature is accompanied by severe hematuria. This condition can be caused by acute renal vein thrombosis, renal artery embolism by thrombotic masses formed in the heart cavities during atrial fibrillation or infective endocarditis. Papillary necrosis is also found - a specific complication of severe pyelonephritis in patients with diabetes mellitus.
Hematuria occurs, as a rule, acutely, against the background of dull or aching pain in the lower back, combined with leukocyturia. After thrombolytic, anticoagulant therapy, surgical removal of a thrombus or an entire kidney, a small amount of blood may be present in the urine for some time.
The most common cause of hematuria in adults. The mechanism of occurrence of hematuria in KSD is associated with trauma to the renal pelvis or the wall of the ureter with a calculus. Blood appears during an attack of renal colic, accompanied by severe pain, nausea, and vomiting. The degree of hematuria depends on the extent of the injury.
Microscopy often reveals a large number of different crystals - calcium oxalates, phosphates, crystals of ammonium uric acid, uric acid. Due to the formed obstruction to the outflow of urine, an infection often joins, as evidenced by the detection of leukocytes and bacteria in the urine. Outside of an attack, blood is usually absent. Hematuria completely stops after surgical removal of stones.
Hematuria with cystitis is quite rare, more often it is observed with polyposis or bladder stones. Possible hemorrhagic cystitis with severe hematuria - with schistosomiasis (parasitic invasion) of the bladder or as an adverse adverse reaction to long-term use of the cytotoxic drug cyclophosphamide.
With a tumor of the bladder, hematuria is considered a constant symptom, and in people suffering from inflammation of the prostate or urethra (prostatitis, urethritis), it is extremely rare. In this case, hematuria is accompanied by leukocyturia, sometimes bacteriuria.
The presence of red blood cells in the urine may be associated with a malfunction of the blood coagulation system. These include congenital or acquired coagulopathy (thrombotic thrombocytopenic purpura, immune thrombocytopenia and other hemorrhagic diathesis), incl. against the background of the use of drugs (anticoagulants, antiplatelet agents).
Blood also enters the urine due to increased hydrostatic pressure in the renal vessels, which occurs in cardiovascular diseases - chronic heart failure and malignant arterial hypertension. Congestive hematuria quickly subsides after improvement in the pumping function of the heart and normalization of blood pressure.
Gross hematuria
If hematuria is detected, it is imperative to consult a general practitioner, nephrologist or urologist to find out the cause of its development. Of great importance in the differential diagnosis of the etiological factor are physical and anamnestic data. It is clarified whether the appearance of hematuria was preceded by an infection of the upper respiratory tract, what medications the patient takes, what chronic diseases he suffers from.
The doctor examines the skin, determines the presence of edema, measures blood pressure, body temperature, performs auscultation of the heart, asks about back pain, checks Pasternatsky's symptom. To clarify the localization of the bleeding site, a 3-glass test is carried out: the predominance of blood in 1 serving of urine indicates damage to the urethra or prostate, in 2 - to damage to the bladder, in 3 or in all servings - to renal hematuria.
When OAM draws attention to the presence of other changes - leukocyturia, proteinuria, bacteriuria. Microscopic examination of the urine sediment determines the ratio of unchanged and dysmorphic erythrocytes. The presence of more than 75-80% of erythrocytes with altered morphology indicates damage to the glomeruli of the kidneys. Also in favor of glomerular pathology is the detection of erythrocyte cylinders, acanthocytes.
If a urinalysis shows a positive reaction to blood test strips, and erythrocytes are not detected by microscopy, a differential diagnosis with hemoglobinuria and myoglobinuria may be required, because the test strip reagent area is equally sensitive to erythrocytes, to free hemoglobin and myoglobin. Additional research methods are assigned:
There are no independent methods for correcting hematuria. To eliminate this laboratory phenomenon, it is necessary to treat the underlying disease. In the case of the development of hematuria while taking an anticoagulant, it is recommended to reduce the dosage or completely cancel it. The following drugs are used as conservative therapy:
Patients with KSD undergo shock wave lithotripsy or laparoscopic stone removal, with polycystic, benign tumor, kidney infarction - resection, nephrostomy or total nephrectomy. With a pronounced bilateral lesion of the renal tissue with the development of terminal renal failure, according to vital indications, kidney transplantation can be performed.
Hematuria is a rather serious clinical and laboratory sign, upon detection of which you should immediately contact a specialist. The prognosis for life is determined by the disease in which blood appeared in the urine - the most favorable for cystitis or prostatitis and extremely unfavorable for rapidly progressive glomerulonephritis or kidney tumors.