Hematuria

Introduction to hematuria Normal urine contains a very small amount of red blood cells. Uncentrifuged urine can have 0 to 2 red blood cells per high power field under the microscope. If it exceeds this number, it is hematuria. First, according to the accompanying symptoms of hematuria to distinguish different hematuria, if hematuria with frequent urination, urgency, dysuria, especially with dysuria, mostly for urinary tract infections, stones, etc. can be diagnosed based on medical history, clinical symptoms and laboratory data . basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: cystitis, renal tuberculosis, kidney tumor

Hematuria

Urinary and urinary tract adjacent organ diseases (45%):

Such as inflammation of the urinary organs, stones, tumors, diverticulum, polyps, malformations or vascular abnormalities, parasitic diseases, trauma, etc., this is the most common cause of hematuria. Such as prostatitis, acute appendicitis, acute pelvic inflammatory disease, colorectal cancer.

Systemic disease (15%):

1 infection: such as infective endocarditis, sepsis, epidemic hemorrhagic fever, scarlet fever, leptospirosis, filariasis; 2 blood diseases: such as thrombocytopenic purpura, allergic purpura, leukemia, hemophilia; Connective tissue diseases: such as systemic lupus erythematosus, nodular polyarteritis; 4 cardiovascular diseases: such as acute hypertensive disease, renal pelvis, renal artery embolism, renal infarction.

Drug and chemical factors and others (10%):

Drugs are chemicals that affect the body's physiological, biochemical, and pathological processes to prevent, diagnose, treat, and plan for cancer. Side effects or toxic effects such as sulfonamides, anticoagulants, cyclophosphamide, amalgam, mannitol, cantharidin, etc. Such as hematuria after exercise.

Hematuria prevention

When hematuria is found, it is first necessary to determine whether it is true hematuria, that is, to exclude pseudo-hematuria and red-colored urine caused by some reasons. The former is caused by bleeding in the urine caused by menstruation, hemorrhage or urethral opening; the latter Such as exposure to certain pigments or oral administration of rifampicin and certain toxicants (phenol, carbon monoxide, chloroform, snake venom), drugs (sulfonamide, quinine), crush injury, burns, malaria, mistyped blood transfusion and other causes of hemoglobin Urine or myoglobinuria, and transient hematuria can be caused by pollen, chemical substances or drug allergies. After menstrual period, after intense exercise, viral infection can also occur, generally no significance, when eliminating the above various situations, and doing more The secondary examination should be paid attention to when hematuria is diagnosed. The diagnosis is made by medical history, physical examination, laboratory examination and other auxiliary examinations. After the diagnosis of true hematuria, the diagnosis of hematuria should be performed to distinguish whether hematuria comes from the renal parenchyma or from the urinary tract:

1 If a cast, especially a red blood cell cast, is found in the urine sediment, indicating that the bleeding is from the renal parenchyma;

2 hematuria with more severe proteinuria is almost a sign of glomerular hematuria;

3 If the type of tube containing immunoglobulin can be found in the urine, it is mostly renal hemorrhage;

4 hematuria caused by glomerular disease, most of the red blood cells are deformed, their shapes are different, the size is significantly different, rather than glomerular hematuria, the majority of red blood cells are normal, only a small number of abnormal red blood cells, The cause of non-glomerular hematuria is very complicated. Special attention should be paid to the malignant tumors of the genitourinary system. The two principles of symptomatic treatment of hematuria are also opposite. Glomerular hematuria often requires anticoagulation, antithrombotic, antiplatelet aggregation or blood circulation. Hemostatic therapy is often used for sputum treatment rather than glomerular hematuria.

Hematuria complications Complications cystitis kidney tuberculosis kidney tumor

As a symptom of other diseases, the common causes of hematuria are various nephritis, urinary tract infection, hemorrhagic cystitis, urinary calculi, kidney tuberculosis, kidney tumor, kidney and urethral injury, etc. Hematuria is the above diseases. One of the main symptoms.

Hematuria symptoms common symptoms urinary frequency urgency urgency pain transient gross hematuria side waist and abdomen sudden "... kidney rupture glomerular basement membrane moth phlegm phenomenon kidney area tenderness and cramps prerenal renal insufficiency renal cortical necrosis

1. Patients with renal colic origin from urinary tract obstruction such as stones, cheese substances, blood clots, etc.

2. With bladder irritation (frequent urination, urgency, dysuria), suggesting that the lesion is located in the bladder or posterior urethra.

3. Patients with hypertension can be seen in acute and chronic glomerulonephritis, acute hypertensive disease, congenital polycystic kidney disease, renal artery embolism, nodular polyarteritis.

4. With the lumbar mass can be seen in kidney tumors, congenital polycystic kidney disease.

5. With skin and mucous membrane bleeding, can be seen in sepsis, infective endocarditis, epidemic hemorrhagic fever, leptospirosis, blood disease.

Hematuria examination

Location analysis of hematuria:

1. Primary hematuria: Hematuria is only seen at the beginning of urination, and the lesions are mostly in the urethra.

2. End-stage hematuria: Hematuria occurs at the end of the urination, and the lesions are mostly in the bladder triangle, the bladder neck or the posterior urethra.

3. Whole hematuria: Hematuria occurs in the whole process of urination, and the bleeding site is mostly in the bladder, ureter or kidney.

The above three kinds of hematuria can be distinguished by three cups of urine test.

Hematuria diagnosis

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.

Differential diagnosis

First, according to the accompanying symptoms of hematuria to distinguish different hematuria, if hematuria accompanied by frequent urination, urgency, dysuria, especially with dysuria, mostly urinary tract infections, stones, etc., called painful hematuria; if hematuria does not accompany urine Pain, called painless hematuria, is common in nephritis, kidney tuberculosis, and urinary tumors, especially in older patients, with gross hematuria, which is painless. All aspects should be examined to rule out malignant lesions.

Other systemic symptoms associated with hematuria can also be used to analyze the causes of hematuria. At present, the urinary red blood cell morphology is used to determine the source of hematuria. The coincidence rate is about 90%. The specific method is to take the urine sediment after centrifugation. On the slide, phase contrast microscopy was used to observe the morphology of red blood cells in the urine, glomerular hematuria, and the red blood cells in the urine were deformed red blood cells, that is, red blood cells showed various forms, such as bagels, strawberry-like, water droplets, and even broken red blood cells. It is suggested that hematuria is caused by glomerular lesions, non-glomerular hematuria, and urinary red blood cells are mostly normal or roughly normal.

In addition, gross hematuria should be differentiated from hemoglobinuria. Hemoglobinuria is caused by hemolytic disease, increased free hemoglobin in plasma, crossed the renal threshold, filtered from the glomerulus, and entered the urine, the color of hemoglobinuria It can be red, brown, or even black. It is mainly determined by microscopic examination with hematuria. The urine of hematuria contains a lot of red blood cells, while the hemoglobinuria has no red blood cells. This is the fundamental difference between the two.

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