Hematuria

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What is Hematuria?

Hematuria is the presence of blood or red blood cells in the urine, and it could be a sign of an underlying medical condition. In medical terms, it is the presence of 5 or more red blood cells in all 3 consecutive specimens of urine taken at least 1 week apart.

Is Hematuria a Medical emergency?

Hematuria is not a medical emergency, but it is important to seek immediate medical attention if there is a presence of blood in the urine.

Types

  • Gross Hematuria: The blood in the urine is visible to the naked eye. The urine may be pink, red, smoky, or tea-colored.
  • Microscopic Hematuria: The blood is not visible to the naked eye, but the red blood cells can be seen under a microscope.

Based on the cause it may be:

  • Glomerular Hematuria: Involving the filtering system of the kidney
  • Non-glomerular Hematuria: Due to causes other than those affecting the filtering apparatus of the kidneys

Causes

The causes of blood in urine can exist along the entire urinary tract starting from the kidney and up to the urethra. It is observed that the timing of the appearance of blood in the urine can be an indicator of the site origin of bleeding. When the blood is present throughout the stream, it usually indicates an origin above the bladder, and when blood is present at the start of the stream the origin could be in the urethra. Some of the causes of blood in the urine are as follows:

  • Glomerular Hematuria
    • IgA nephropathy
    • Glomerulonephritis
    • Hereditary nephritis(Alport's syndrome)
    • Glomerular basement membrane disease
  • Non-glomerular Hematuria
    • Urinary stones
    • Kidney infections or pyelonephritis
    • Cancer of the kidney
    • Cancer of the ureters
    • Cancer of the bladder
    • Urinary tract infections
    • Enlargement of the prostate(BPH)
    • Strenuous exercise
    • Sickle cell anemia
    • Medications - chemotherapeutic agents, aspirin, heparin, etc.

Vaginal bleeding can also be a cause of Hematuria.

Risk factors

The risk factors may include:

  • Age - Older men are at a greater risk of Hematuria, due to the probability of an enlarged prostate.
  • Infections
  • Family history
  • Medications - Blood thinners, NSAIDs, some antibiotics such as penicillin.
  • Strenuous exercise

Signs & symptoms

It is a potential sign of an underlying disease. Along with the passage of blood in urine other symptoms may be present and could be suggestive of a probable underlying cause. Some symptoms that may include:

  • Passage of blood clots is mostly seen in Non-glomerular Hematuria
  • Fever, abdominal pain, painful urination, increased frequency are mostly seen in urinary tract infection
  • Early morning swelling around the eyes, weight gain, high blood pressure, scanty urine output, dark-colored urine are mostly seen in Glomerular Hematuria
  • Joint pains, skin rashes are mostly seen in collagen vascular disease

Investigations

The following investigations may be done to evaluate the passing of blood in the urine:

  • Laboratory tests:
    • Urinalysis
    • Phase-contrast microscopic analysis of urine.
    • Urinary calcium
    • Urine culture and sensitivity
    • Renal function tests
    • Complete blood picture, bleeding time and clotting time, prothrombin time.
    • Serologic testing  for ASO and ANA titers
  • Imaging tests:
    • Abdominal ultrasound
    • Voiding cystourethrograms
    • CT or MRI
  • Cystoscopy is done using a cystoscope to visualize the inside of the urethra and the urinary bladder.

Diagnosis

The establishment of the cause of blood in urine is based on medical history, clinical evaluation, and the results of the investigations done.

Course & Stages

It may be clinically grouped as follows:

  • Gross Hematuria
  • Microscopic Hematuria with clinical symptoms
  • Asymptomatic Microscopic Hematuria with proteinuria
  • Isolated Asymptomatic Microscopic Hematuria.

Treatment options

The treatment of Hematuria depends on the underlying cause and may include medical or surgical management as required.

Medical management

Medical management depends on the underlying cause.

Interventional including surgery and indications for surgery

Surgical management depends on the underlying cause.

Complications

The complications that can accompany Hematuria are:

  • Acute clot retention: These blood clots can block the outflow of urine leading to acute urinary retention.
  • Shock
  • Anemia

Prognosis

Early detection and management of the underlying cause of blood in the urine are essential for a good prognosis.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical attention if there is blood in the urine and to have the underlying cause investigated.

Indications for hospitalization if required

Hospitalization is not required, although depending on the underlying cause and the management advice, it may be needed.

Suggested clinical specialist/ Departments to consult for this condition

The condition will be attended to by specialists from the Department of Nephrology, and/or Urology.

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