Hematuria

Introduction Hematuria refers to 3 red blood cells per high-powered field of view in centrifuged urine, or more than 100,000 urinary red blood cell counts in non-centrifugal urine for more than 1 or 1 hour, or more than 500,000 urine sediment counts in 12 hours, all showing red blood cells in urine Abnormal increase is a common urinary system symptom. The causes are urinary tract inflammation, tuberculosis, stones or tumors, trauma, drugs, etc., which have a great impact on the body. The lighter only found red blood cells under the microscope, called microscopic hematuria. The appearance of the heavy one is washed water or contains blood clots, called gross hematuria. Usually 1mL of blood per liter of urine is visible to the naked eye, urine is red or washed water. After finding red urine, it is first necessary to distinguish whether it is true hematuria or pseudo hematuria. Some drugs can cause red urine, such as aminopyrine, phenytoin, rifampicin, phenol red, etc.; need to be distinguished from true hematuria. In recent years, there is no obvious accompanying symptom of hematuria, and most of them are glomerular hematuria, which has been widely regarded and studied.

Cause

1. Kidney and urinary tract disease

(1) Inflammation: acute and chronic glomerulonephritis, acute and chronic pyelonephritis, acute cystitis, urethritis, urinary system tuberculosis, urinary system fungal infections, etc.

(2) stones: renal pelvis, ureter, bladder, urethra, stones in any part, when the stone moves to cut through the urinary tract, it is easy to cause hematuria and easy secondary infection. Large stones can cause urinary tract obstruction and even cause kidney damage.

(3) Tumor: Hematuria can be caused by malignant tumors in any part of the urinary system or malignant tumors of adjacent organs invading the urinary tract.

(4) Trauma: refers to violence and urinary system.

(5) Congenital malformation: polycystic kidney, congenital glomerular basement membrane ultrathin, nephritis, nutcracker phenomenon (the disease is a congenital malformation caused by left renal vein compression between the abdominal aorta and superior mesenteric artery Pressure, causing intractable microscopic hematuria. The right renal vein is directly injected into the inferior vena cava, and the left renal vein must be injected into the inferior vena cava through the angle formed by the abdominal aorta and superior mesenteric artery. Normally, the angle is 45°-60. °, if the congenital angle is too small or is filled with mesenteric fat, enlarged lymph nodes, peritoneal filling can cause the phenomenon of nutcracker. Diagnosis mainly depends on CT, B-ultrasound, renal vein angiography. Treatment must be surgical correction).

2. Systemic diseases

(1) Hemorrhagic diseases: thrombocytopenic purpura, allergic purpura, hemophilia, leukemia, malignant histiocytosis, aplastic anemia, and the like.

(2) connective tissue disease: systemic lupus erythematosus, dermatomyositis, nodular polyarteritis, scleroderma and the like.

(3) Infectious diseases: leptospirosis, epidemic hemorrhagic fever, filariasis, infectious bacterial endocarditis, scarlet fever, and the like.

(4) Cardiovascular diseases: congestive heart failure, renal embolism, and renal vein thrombosis.

(5) Endocrine and metabolic diseases: gout kidney, diabetic nephropathy, hyperparathyroidism.

(6) Physical and chemical factors: such as food allergies, radiation exposure, drugs (such as sulfonamide, phenol, mercury, lead, arsenic poisoning, large infusion of mannitol, glycerol, etc.), poisons, after exercise, etc.

3. Adjacent organ diseases

Tumors of the uterus, vagina or rectum invade the urinary tract.

an examination

Related inspection

Urine Transparency (UCI) Serum Interleukin 8 Urinary Occult Blood (BLD) Prostatic Acid Phosphatase (PAP) r-Semen Protein Determination (r-sm)

Hematuria examination

1. History: The medical history is the basis for the diagnosis of hematuria. According to the possible causes of hematuria, the history of urinary system diseases, the history of systemic diseases and the history of adjacent organs, the history of medication, the history of drug allergy, and the history of trauma are carefully examined.

2. Physical examination: In addition to paying attention to the whole body examination, the urinary system should be the focus of physical examination, tenderness and sputum pain in the kidney area, upper ureteral tenderness point, and double kidney diagnosis.

3. Laboratory examination: Urine routine examination is the most common and most important examination, in addition to the examination of renal function. According to the possible causes, selective examination of autoantibodies, plasma protein electrophoresis, examination of blood coagulation and hemolysis mechanism, and examination of bone marrow are necessary for the diagnosis of hematuria caused by blood diseases. Hematuria with a tendency to systemic bleeding should be investigated for DIC, hemorrhagic fever antibodies. The examination of the urine of the phase microscope is a simple and non-invasive examination. The red blood cells filtered by the glomerulus are often deformed to be filtered out, and can be expressed in a sang shape, a fusiform shape, a folded shape, and a polygonal shape. In the triangle, the deformed red blood cells generally account for more than 80%; the red blood cells that do not pass through the glomerulus are often discharged in the original form, and sometimes only the red blood cells that are shrunk due to intracellular dehydration, unlike the deformed red blood cells.

4. Device inspection:

(1) B-ultrasound: It is helpful for diagnosing kidney size, contour, hydronephrosis, upper ureteral dilatation, stones, tumors, nutcracker phenomenon, and polycystic kidney disease. When the nutcracker phenomenon occurs, the left renal vein diameter on the left side of the abdominal aorta is more than one-fold wider than the left renal vein in front of the abdominal aorta.

(2) CT and MRI examination: mainly used for tumors and stones. Diagnosis of tuberculosis.

(3) Examination of cystoscopy: it is helpful for the diagnosis of bladder tuberculosis, tumors, stones and ulcers. Due to impaired renal function, it is not possible to perform retrograde angiography at the same time as cystoscopy, in order to determine the location and cause of obstruction.

(4) Kidney biopsy: It is necessary to determine the etiology and nature of the renal disease.

(5) ECT examination: It is helpful for the diagnosis of glomerular filtration rate, filtration function and renal blood flow renal infarction.

Differential diagnosis

Red urine is not necessarily hematuria and needs to be carefully identified. If the urine is dark red or soy sauce color, no turbidity and no precipitation, no or only a small amount of red blood cells in the microscopic examination, found in hemoglobinuria; brown red or wine color, no turbidity, no red blood cells seen in porphyrin urine; some drugs such as Rhubarb, rifampicin, or some red vegetables can also be red urine, but no red blood cells on the microscopic examination. Diagnosis is based on cytology.

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