fbpx
Wikipedia

Hematuria

January 01, 1970

Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine.[1] "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test.[2] Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate.[3] Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise.[4] These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney.[1] But not all red urine is hematuria.[5] Other substances such as certain medications and foods (e.g. blackberries, beets, food dyes) can cause urine to appear red.[5] Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria.[6] A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field.[6] When hematuria is detected, a thorough history and physical examination with appropriate further evaluation (e.g. laboratory testing) can help determine the underlying cause.[1]

Hematuria (differential diagnosis)
Other namesHaematuria, erythrocyturia, blood in the urine
Visible hematuria that is tea-colored
SpecialtyNephrology, Urology
SymptomsBlood in the urine
CausesUrinary tract infection, kidney stone, bladder cancer, kidney cancer

Differential diagnosis edit

 

Hematuria can be classified according to visibility, anatomical origin, and timing of blood during urination.[1][6]

  • In terms of visibility, hematuria can be visible to the naked eye (termed "gross hematuria") and may appear red or brown (sometimes referred to as tea-colored), or it can be microscopic (i.e. not visible but detected with a microscope or laboratory test).[2][6] Microscopic hematuria is present when there are three or more red blood cells per high power field.[3]
  • In terms of the anatomical origin, blood or red blood cells can enter and mix with urine at multiple anatomical sites within the urinary system, including the kidney, ureter, urinary bladder, and urethra, and in men, the prostate.[1] Additionally, menstruation in women may cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria.[3] The causes corresponding to these anatomic locations can be divided into glomerular and non-glomerular causes, referring to the involvement of the glomerulus of the kidney.[4] Non-glomerular causes can be further subdivided into the upper urinary tract and lower urinary tract causes.[1]
  • In terms of the timing during urination, hematuria can be initial, terminal or total, meaning blood can appear in the urine at the onset, midstream, or later.[1][5] If it appears soon after the onset of urination, a distal site is suggested.[5] A longer delay suggests a more proximal lesion.[5] Hematuria that occurs throughout urination suggests that bleeding is occurring above the level of the bladder.[5]

Many causes may present as either visible hematuria or microscopic hematuria, and so the differential diagnosis is frequently organized based on glomerular and non-glomerular causes.[4][6]

Glomerular hematuria edit

 
Postrenal hematuria - the presence of blood in urine (because of damage to the urethra and prostate).

Hematuria due to a glomerular source commonly presents as dysmorphic red blood cells (misshapen red blood cells) or red cell casts (small tubular structures made up of red blood cell components) on urine microscopy. This occurs due to the red blood cells being deformed as they pass through the glomerular capillaries into the renal tubules and eventually into the urinary system.[7] Normally, red blood cells should never pass from the glomerular capillary into the renal tubule, and this is always a pathological process. Glomerular causes include:

Non-glomerular hematuria edit

Visible blood clots in the urine indicate a non-glomerular cause.[6] Non-glomerular causes include:

Mimickers of hematuria edit

Pigmenturia edit

Not all red or brown urine is caused by hematuria.[3] Other substances such as certain medications and certain foods can cause urine to appear red.[3]

Medications that may cause urine to appear red include:

Foods that may cause urine to appear red include:

False positive urine dipstick edit

A urine dipstick may be falsely positive for hematuria due to other substances in the urine.[6] While the urine dipstick test is able to recognize heme in red blood cells, it also identifies free hemoglobin and myoglobin.[6] Free hemoglobin may be found in the urine resulting from hemolysis, and myoglobin may be found in the urine resulting from rhabdomyolysis (muscle breakdown).[6][5] Thus, a positive dipstick test does not necessarily indicate hematuria; rather, microscopy of the urine showing three of more red blood cells per high power field confirms hematuria.[6][3]

Menstruation edit

In women, menstruation may cause the appearance of hematuria and may result in a urine dipstick test positive for hematuria.[3] Menstruation can be ruled out as a cause of hematuria by inquiring about menstruation history and ensuring the urine specimen is collected without menstrual blood.[3]

In children edit

Common causes of hematuria in children[11] are:[12]

Evaluation edit

The evaluation of hematuria is dependent upon the visibility of the blood in the urine (i.e. visible/gross vs microscopic hematuria).[6] Visible hematuria must be investigated, as it may be due to a pathological cause.[1][6] In those with visible hematuria, urological cancer (most frequently bladder or kidney cancer) is discovered in 20–25%.[3] Hematuria alone without accompanying symptoms should be raise suspicion of malignancy of the urinary tract until proven otherwise.[5] The initial evaluation of patients presenting with signs and symptoms that are consistent of hematuria include assessment of hemodynamic status, underlying cause of hematuria, and ensuring urinary drainage. These steps include assessment of the patient's heart rate, blood pressure, a physician exam taken by a healthcare professional, and blood work to ensure the patient's hemodynamic status is adequate.[13] It is important to obtain a detailed history from the patient (i.e. recreational, occupational, and medication exposures) as this information can be helpful in suggesting a cause of hematuria.[14] The physical exam can also be helpful in identifying a cause of the hematuria as certain signs found on the physical exam can suggest specific causes of the hematuria.[14] In the event the initial evaluation of hematuria does not reveal an underlying cause then evaluation by a physician who specializes in Urology may proceed. This medical evaluation may consist of, but is not limited too, a history and physical exam taken by healthcare personnel, laboratory studies (i.e. blood work), cystoscopy, and specialized imaging procedures (i.e. CT or MRI).[13]

Visible hematuria edit

The first step in evaluation of red or brown colored urine is to confirm true hematuria with urinalysis and urine microscopy, where hematuria is defined by three of more red blood cells per high power field.[3] Although a urine dipstick test may be used, it can give false positive or false negative results.[4] In gathering information, it is important to inquire about recent trauma, urologic procedures, menses, and culture-documented urinary tract infection.[3] If any of these are present, it is appropriate to repeat a urinalysis with urine microscopy in 1 to 2 weeks or after treatment of the infection.[6][3] If the results of the urinalysis and urine microscopy reveal a glomerular origin of hematuria (indicated by proteinuria or red blood cell casts), consultation with a nephrologist should be made.[6] If the results of the urinalysis indicate a non-glomerular origin, a microbiological culture of the urine should be performed, if it has not been done already.[6] If the culture is positive (indicating a bladder infection), urinalysis and urine microscopy should be repeated following treatment to confirm resolution of the hematuria.[6] If the culture is negative or if hematuria persists after treatment, CT urogram or renal ultrasound and cystoscopy should be performed.[6][7] Hemodynamic stability should be monitored and a complete blood count should be ordered to assess for anemia.[3]

Microscopic hematuria edit

 
Red blood cells seen on light microscopy on urinary cytology, next to benign urothelial cells (pap stain).

After detecting and confirming hematuria with urinalysis and urine microscopy, the first step in evaluation of microhematuria is to rule out benign causes.[15] Benign causes include urinary tract infection, viral illness, kidney stone, recent intense exercise, menses, recent trauma, or recent urological procedure.[15] After benign causes have resolved or been treated, a repeat urinalysis and urine microscopy is warranted to ensure cessation of hematuria.[15] If hematuria persists (even if there is a suspected cause), the next step is to stratify the risk of the person for urothelial cancer into low, intermediate, or high risk to determine next steps.[16] To be in the low risk category, one must satisfy all of the following criteria: Has never smoked tobacco or smoked less than 10 pack-years; is a female less than 50 years old or a male less than 40 years old; has 3–10 red blood cells per high power field; has not had microscopic hematuria before; and has no other risk factors for urothelial cancer.[16] To be in the intermediate risk category, one must satisfy any of the following criteria: Has smoked 10–30 pack-years; is a female 50–59 years old or a male aged 40–59 years old; has 11–25 red blood cells per high power field; or was previously a low-risk patient with persistent microscopic hematuria and has 3–25 red blood cells per high power field.[16] To be in the high risk category, one must satisfy any of the following criteria: Has smoked more than 30 pack-years; is older than 60 years of age; or has above 25 red blood cells per high power field on any urinalysis.[16] For the low risk category, the next step is to either repeat a urinalysis with urine microscopy in 6 months or perform a cystoscopy and renal ultrasound.[16] For the intermediate risk category, the next step is to perform a cystoscopy and renal ultrasound.[16] For the high risk category, the next step is to perform a cystoscopy and CT urogram.[16] If an underlying cause for hematuria is discovered, it should be managed appropriately.[16] However, if no underlying cause is discovered, the hematuria should be re-evaluated with urinalysis and urine microscopy within 12 months.[16] Additionally, for all risk categories, if a nephrologic origin is suspected, consultation of a nephrologist should be made.[16]

Pathophysiology edit

The pathophysiology of hematuria can often be explained by damage to the structures of the urinary system, including the kidney, ureter, urinary bladder, and urethra, and in men, the prostate.[4][1] Common mechanisms include structural disruption to the glomerular basement membrane and mechanical or chemical erosion of the mucosal surfaces of the genitourinary tract.[4]

Management edit

Medical emergency: acute clot retention edit

 
A 60cc/mL Toomey syringe.
  1. Fill syringe with saline.
  2. Connect syringe to a catheter port.
  3. Instill 180cc of saline.
  4. Draw back 180cc of bladder urine.
  5. Dispose of medical waste.
  6. Repeat until all clots are removed.

Acute clot retention is one of three emergencies that can occur with hematuria.[17] The other two are anemia and shock.[17] Blood clots can prevent urine outflow through either ureter or the bladder.[17] This is known as acute urinary retention.

Blood clots that remain in the bladder are digested by urinary urokinase producing fibrin fragments.[17] These fibrin fragments are natural anticoagulants and promote ongoing bleeding from the urinary tract.[17] Removing all blood clots prevents the formation of this natural anticoagulant.[17] This in turns facilitates the cessation of bleeding from the urinary tract.[17]

The acute management of obstructing clots is the placement of a large (22–24 French) urethral Foley catheter.[17] Clots are evacuated with a Toomey syringe and saline irrigation.[17] If this does not control the bleeding, management should escalate to continuous bladder irrigation (CBI) via a three-port urethral catheter.[17] If both a large urethral Foley catheter and CBI fail, an urgent cystoscopy in the operating room will be necessary.[17] Lastly, a transfusion and/or a correction of a coexisting coagulopathy may be necessary.[17]

Medical emergency: urosepsis edit

Urosepsis is defined as sepsis caused by a urogenital tract infection and comprises about 25% of all sepsis cases.[18] Urosepsis is the result of a systemic inflammatory response to infection and can be identified by numerous signs and symptoms (e.g. fever, hypothermia, tachycardia, and leukocytosis).[18] Signs and symptoms that indicate a urogential tract infection is the source of the sepsis may include, but are not limited to, flank pain, costovertebral angle tenderness, pain with micturition, urinary retention, and scrotal pain.[18] In terms of the visibility, hematuria can be visible to the naked eye (termed "gross hematuria") and may appear red or brown (sometimes referred to as tea-colored), or it can be microscopic (i.e. not visible to the eye but detected of urosepsis.[18] In addition to imaging tests, patients may be treated with antibiotics to relieve the infection and intravenous fluids to maintain cardiovascular and renal perfusion.[18] Acute management of hemodynamic status, in the event intravenous fluids are unsuccessful, may include the use of vasopressor medications and the placement of a central venous line.[18]

Epidemiology edit

In the United States, microscopic hematuria has a prevalence of somewhere between 2% and 31%.[19][7] Higher rates exist in individuals older than 60 years of age and those with a current or prior history of smoking.[19] Only a fraction of individuals with microhematuria are diagnosed with a urologic cancer.[19] When asymptomatic populations are screened with dipstick and/or microscopy medical testing about 2% to 3% of those with hematuria have a urologic malignancy.[19] Routine screening is not recommended.[19][7] Individuals with risk factors who undergo repeated testing have higher rates of urologic malignancies.[19] These risks factors include age (> 40 years), male gender, previous or current smoking, chemical exposure (e.g., benzenes, hydrocarbons, aromatic amines), history of chemotherapy (alkylating agents, ifosfamide), prolonged foreign body in the bladder (such as a bladder catheter), prior pelvic radiation therapy, or greater than 25 red blood cells per high powered field on urine microscopy.[19][7]

The prevalence of microscopic hematuria in North Africa is very high due to the high prevalence of the blood fluke schistosoma haematobium, which chronically infects the urinary tract.[7]

In pediatric populations, the prevalence is 0.5–2%.[20] Risks factor include older age and female gender.[21] About 5% of individuals with microscopic hematuria receive a cancer diagnosis. 40% of individuals with macroscopic hematuria (blood easily visible in the urine) receive a cancer diagnosis.[22]

References edit

  1. ^ a b c d e f g h i Papadakis, Maxine A.; McPhee, Stephen J.; Rabow, Michael W. (14 September 2021). Current medical diagnosis & treatment 2022. 23-02: Hematuria. ISBN 978-1-264-26938-9. OCLC 1268130534.
  2. ^ a b Kirkpatrick, Wanda G. (1990), "Chapter 184 – Hematuria", in Walker, H. Kenneth; Hall, W. Dallas; Hurst, J. Willis (eds.), Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.), Boston: Butterworths, ISBN 978-0-409-90077-4, PMID 21250137, retrieved 2022-01-17
  3. ^ a b c d e f g h i j k l m n o Partin, Alan W.; Dmochowski, Roger R.; Kavoussi, Louis R.; Peters, Craig, eds. (2021). "Evaluation and Management of Hematuria". Campbell-Walsh-Wein urology (Twelfth ed.). Philadelphia, Pennsylvania. ISBN 978-0-323-54642-3. OCLC 1130700336.{{cite book}}: CS1 maint: location missing publisher (link)
  4. ^ a b c d e f g h i j k l m n o p q r s Saleem, Muhammad O.; Hamawy, Karim (2022), "Hematuria", StatPearls, Treasure Island, Florida: StatPearls Publishing, PMID 30480952, retrieved 2022-01-17
  5. ^ a b c d e f g h McAninch, Jack W.; Lue, Tom (2013). "Chapter 3: Symptoms of Disorders of the Genitourinary Tract". Smith & Tanagho's General Urology. McGraw-Hill Education.
  6. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae Stern, Scott D. C. Symptom to diagnosis: an evidence-based guide. Chapter 21-1: Approach to the Patient with Hematuria – Case 1. OCLC 1121597721.
  7. ^ a b c d e f Ingelfinger, Julie R. (8 July 2021). "Hematuria in Adults". New England Journal of Medicine. 385 (2): 153–163. doi:10.1056/NEJMra1604481.
  8. ^ Hashmi, Mydah S.; Pandey, Jyotsna (2022), "Nephritic Syndrome", StatPearls, Treasure Island, Florida: StatPearls Publishing, PMID 32965911, retrieved 2022-01-19
  9. ^ Izzo, Joseph L.; Sica, Domenic A.; Black, Henry Richard (2008). Hypertension Primer. Lippincott Williams & Wilkins. p. 382. ISBN 978-0-7817-8205-0.
  10. ^ "Changes in Urine; Symptoms, Causes & Treatment". Cleveland Clinic. Retrieved 2022-09-12.
  11. ^ "Hematuria in Children". National Kidney Foundation. 2015-12-24. Retrieved 2023-03-11.
  12. ^ Pade, Kathryn H.; Liu, Deborah R. (September 2014). "An evidence-based approach to the management of hematuria in children in the emergency department". Pediatric Emergency Medicine Practice. 11 (9): 1–13, quiz 14. ISSN 1549-9650. PMID 25296518.
  13. ^ a b Avellino, Gabriella J.; Bose, Sanchita; Wang, David S. (June 2016). "Diagnosis and Management of Hematuria". Surgical Clinics of North America. 96 (3): 503–515. doi:10.1016/j.suc.2016.02.007. PMID 27261791.
  14. ^ a b Yun, Edward J.; Meng, Maxwell V.; Carroll, Peter R. (March 2004). "Evaluation of the patient with hematuria". Medical Clinics of North America. 88 (2): 329–343. doi:10.1016/S0025-7125(03)00172-X. PMID 15049581.
  15. ^ a b c Davis, Rodney; Jones, J. Stephen; Barocas, Daniel A.; Castle, Erik P.; Lang, Erich K.; Leveillee, Raymond J.; Messing, Edward M.; Miller, Scott D.; Peterson, Andrew C.; Turk, Thomas M. T.; Weitzel, William (2012-12-01). "Diagnosis, Evaluation and Follow-Up of Asymptomatic Microhematuria (AMH) in Adults: AUA Guideline". Journal of Urology. 188 (6S) (published 2012): 2473–2481. doi:10.1016/j.juro.2012.09.078. PMID 23098784.
  16. ^ a b c d e f g h i j Barocas, Daniel A.; Boorjian, Stephen A.; Alvarez, Ronald D.; Downs, Tracy M.; Gross, Cary P.; Hamilton, Blake D.; Kobashi, Kathleen C.; Lipman, Robert R.; Lotan, Yair; Ng, Casey K.; Nielsen, Matthew E. (2020-10-01). "Microhematuria: AUA/SUFU Guideline". Journal of Urology. 204 (4): 778–786. doi:10.1097/JU.0000000000001297. PMID 32698717. S2CID 220717643.
  17. ^ a b c d e f g h i j k l Kaplan, Damara; Kohn, Taylor. . American Urological Association. Archived from the original on 2019-11-28. Retrieved 2019-12-11.
  18. ^ a b c d e f Wagenlehner, Florian M. E.; Lichtenstern, Christoph; Rolfes, Caroline; Mayer, Konstantin; Uhle, Florian; Weidner, Wolfgang; Weigand, Markus A. (June 2013). "Diagnosis and management for urosepsis: Items in urosepsis". International Journal of Urology. 20 (10): 963–970. doi:10.1111/iju.12200. PMID 23714209.
  19. ^ a b c d e f g Coplen, D. E. (January 2013). "Diagnosis, Evaluation and Follow-Up of Asymptomatic Microhematuria (AMH) in Adults: AUA Guideline". Yearbook of Urology. 2013: 1–2. doi:10.1016/j.yuro.2013.07.019. ISSN 0084-4071.
  20. ^ Shah, Samir; Ronan, Jeanine C.; Alverson, Brian (2014). Step-up to pediatrics (first ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. pp. 175–176. ISBN 978-1451145809. OCLC 855779297.
  21. ^ Cohen, Robert A.; Brown, Robert S. (2003-06-05). "Clinical practice. Microscopic hematuria". The New England Journal of Medicine. 348 (23): 2330–2338. doi:10.1056/NEJMcp012694. ISSN 1533-4406. PMID 12788998.
  22. ^ Sharp, Victoria; Barnes, Kerri D.; Erickson, Bradley D. (December 1, 2013). "Assessment of Asymptomatic Microscopic Hematuria in Adults". American Family Physician. 88 (11): 747–754. PMID 24364522.

External links edit

  Media related to Hematuria at Wikimedia Commons

January 01, 1970
hematuria, haematuria, defined, presence, blood, blood, cells, urine, gross, hematuria, occurs, when, urine, appears, brown, colored, presence, blood, also, subtle, only, detectable, with, microscope, laboratory, test, blood, that, enters, mixes, with, urine, . Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine 1 Gross hematuria occurs when urine appears red brown or tea colored due to the presence of blood Hematuria may also be subtle and only detectable with a microscope or laboratory test 2 Blood that enters and mixes with the urine can come from any location within the urinary system including the kidney ureter urinary bladder urethra and in men the prostate 3 Common causes of hematuria include urinary tract infection UTI kidney stones viral illness trauma bladder cancer and exercise 4 These causes are grouped into glomerular and non glomerular causes depending on the involvement of the glomerulus of the kidney 1 But not all red urine is hematuria 5 Other substances such as certain medications and foods e g blackberries beets food dyes can cause urine to appear red 5 Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria 6 A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin a protein excreted into urine during rhabdomyolysis A positive urine dipstick test should be confirmed with microscopy where hematuria is defined by three or more red blood cells per high power field 6 When hematuria is detected a thorough history and physical examination with appropriate further evaluation e g laboratory testing can help determine the underlying cause 1 Hematuria differential diagnosis Other namesHaematuria erythrocyturia blood in the urineVisible hematuria that is tea coloredSpecialtyNephrology UrologySymptomsBlood in the urineCausesUrinary tract infection kidney stone bladder cancer kidney cancer Contents 1 Differential diagnosis 1 1 Glomerular hematuria 1 2 Non glomerular hematuria 1 3 Mimickers of hematuria 1 3 1 Pigmenturia 1 3 2 False positive urine dipstick 1 3 3 Menstruation 2 In children 3 Evaluation 3 1 Visible hematuria 3 2 Microscopic hematuria 4 Pathophysiology 5 Management 5 1 Medical emergency acute clot retention 5 2 Medical emergency urosepsis 6 Epidemiology 7 References 8 External linksDifferential diagnosis edit nbsp Hematuria can be classified according to visibility anatomical origin and timing of blood during urination 1 6 In terms of visibility hematuria can be visible to the naked eye termed gross hematuria and may appear red or brown sometimes referred to as tea colored or it can be microscopic i e not visible but detected with a microscope or laboratory test 2 6 Microscopic hematuria is present when there are three or more red blood cells per high power field 3 In terms of the anatomical origin blood or red blood cells can enter and mix with urine at multiple anatomical sites within the urinary system including the kidney ureter urinary bladder and urethra and in men the prostate 1 Additionally menstruation in women may cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria 3 The causes corresponding to these anatomic locations can be divided into glomerular and non glomerular causes referring to the involvement of the glomerulus of the kidney 4 Non glomerular causes can be further subdivided into the upper urinary tract and lower urinary tract causes 1 In terms of the timing during urination hematuria can be initial terminal or total meaning blood can appear in the urine at the onset midstream or later 1 5 If it appears soon after the onset of urination a distal site is suggested 5 A longer delay suggests a more proximal lesion 5 Hematuria that occurs throughout urination suggests that bleeding is occurring above the level of the bladder 5 Many causes may present as either visible hematuria or microscopic hematuria and so the differential diagnosis is frequently organized based on glomerular and non glomerular causes 4 6 Glomerular hematuria edit nbsp Postrenal hematuria the presence of blood in urine because of damage to the urethra and prostate Hematuria due to a glomerular source commonly presents as dysmorphic red blood cells misshapen red blood cells or red cell casts small tubular structures made up of red blood cell components on urine microscopy This occurs due to the red blood cells being deformed as they pass through the glomerular capillaries into the renal tubules and eventually into the urinary system 7 Normally red blood cells should never pass from the glomerular capillary into the renal tubule and this is always a pathological process Glomerular causes include IgA nephropathy 4 Thin glomerular basement membrane disease 4 Hereditary nephritis Alport s disease 6 Hemolytic uremic syndrome 6 Postinfectious glomerulonephritis 4 group A b hemolytic streptococcus pyogenes Membranoproliferative glomerulonephritis 4 Lupus nephritis 4 Henoch Shonlein purpura 6 Nephritic syndrome 8 Nephrotic syndrome 4 Polycystic kidney disease 4 Idiopathic hematuria 9 Non glomerular hematuria edit Visible blood clots in the urine indicate a non glomerular cause 6 Non glomerular causes include Urinary tract infections such as pyelonephritis cystitis prostatitis and urethritis 4 6 Kidney stones 4 Cancers such as renal cell carcinoma and bladder cancer particularly transitional cell carcinoma and in men prostate cancer 4 Urinary tract strictures 6 Benign prostatic hyperplasia 6 Renal papillary necrosis 6 Trauma or damage to the lining of the urinary tract 4 Intense exercise 4 Increased tendency to bleed due to acquired or genetic conditions e g sickle cell disease or vitamin K deficiency bleeding or certain medications e g blood thinners 4 6 Mimickers of hematuria edit Pigmenturia edit Not all red or brown urine is caused by hematuria 3 Other substances such as certain medications and certain foods can cause urine to appear red 3 Medications that may cause urine to appear red include Phenazopyridine 6 Nitrofurantoin 6 Doxorubicin 6 Rifampicin 6 Foods that may cause urine to appear red include Blackberries 6 Food dyes 6 Beets 3 Rhubarb 3 Fava beans 10 False positive urine dipstick edit A urine dipstick may be falsely positive for hematuria due to other substances in the urine 6 While the urine dipstick test is able to recognize heme in red blood cells it also identifies free hemoglobin and myoglobin 6 Free hemoglobin may be found in the urine resulting from hemolysis and myoglobin may be found in the urine resulting from rhabdomyolysis muscle breakdown 6 5 Thus a positive dipstick test does not necessarily indicate hematuria rather microscopy of the urine showing three of more red blood cells per high power field confirms hematuria 6 3 Menstruation edit In women menstruation may cause the appearance of hematuria and may result in a urine dipstick test positive for hematuria 3 Menstruation can be ruled out as a cause of hematuria by inquiring about menstruation history and ensuring the urine specimen is collected without menstrual blood 3 In children editCommon causes of hematuria in children 11 are 12 Fever Strenuous exercise Acute nephritis Congenital abnormalities Non vascular ureteropelvic junction obstruction posterior urethral valves urethral prolapse urethral diverticulum and multicystic dysplastic kidney Vascular arteriovenous malformations hereditary hemorrhagic telangiectasias renal vein thrombosis in newborns Urinary stones Coagulation disorders Mechanical trauma masturbation foreign body Nephritic syndrome IgA nephropathy Post streptococcal glomerulonephritis Benign familial hematuria Alport syndrome Sickle cell trait or disease Evaluation editThe evaluation of hematuria is dependent upon the visibility of the blood in the urine i e visible gross vs microscopic hematuria 6 Visible hematuria must be investigated as it may be due to a pathological cause 1 6 In those with visible hematuria urological cancer most frequently bladder or kidney cancer is discovered in 20 25 3 Hematuria alone without accompanying symptoms should be raise suspicion of malignancy of the urinary tract until proven otherwise 5 The initial evaluation of patients presenting with signs and symptoms that are consistent of hematuria include assessment of hemodynamic status underlying cause of hematuria and ensuring urinary drainage These steps include assessment of the patient s heart rate blood pressure a physician exam taken by a healthcare professional and blood work to ensure the patient s hemodynamic status is adequate 13 It is important to obtain a detailed history from the patient i e recreational occupational and medication exposures as this information can be helpful in suggesting a cause of hematuria 14 The physical exam can also be helpful in identifying a cause of the hematuria as certain signs found on the physical exam can suggest specific causes of the hematuria 14 In the event the initial evaluation of hematuria does not reveal an underlying cause then evaluation by a physician who specializes in Urology may proceed This medical evaluation may consist of but is not limited too a history and physical exam taken by healthcare personnel laboratory studies i e blood work cystoscopy and specialized imaging procedures i e CT or MRI 13 Visible hematuria edit The first step in evaluation of red or brown colored urine is to confirm true hematuria with urinalysis and urine microscopy where hematuria is defined by three of more red blood cells per high power field 3 Although a urine dipstick test may be used it can give false positive or false negative results 4 In gathering information it is important to inquire about recent trauma urologic procedures menses and culture documented urinary tract infection 3 If any of these are present it is appropriate to repeat a urinalysis with urine microscopy in 1 to 2 weeks or after treatment of the infection 6 3 If the results of the urinalysis and urine microscopy reveal a glomerular origin of hematuria indicated by proteinuria or red blood cell casts consultation with a nephrologist should be made 6 If the results of the urinalysis indicate a non glomerular origin a microbiological culture of the urine should be performed if it has not been done already 6 If the culture is positive indicating a bladder infection urinalysis and urine microscopy should be repeated following treatment to confirm resolution of the hematuria 6 If the culture is negative or if hematuria persists after treatment CT urogram or renal ultrasound and cystoscopy should be performed 6 7 Hemodynamic stability should be monitored and a complete blood count should be ordered to assess for anemia 3 Microscopic hematuria edit This section needs to be updated Please help update this article to reflect recent events or newly available information March 2023 nbsp Red blood cells seen on light microscopy on urinary cytology next to benign urothelial cells pap stain After detecting and confirming hematuria with urinalysis and urine microscopy the first step in evaluation of microhematuria is to rule out benign causes 15 Benign causes include urinary tract infection viral illness kidney stone recent intense exercise menses recent trauma or recent urological procedure 15 After benign causes have resolved or been treated a repeat urinalysis and urine microscopy is warranted to ensure cessation of hematuria 15 If hematuria persists even if there is a suspected cause the next step is to stratify the risk of the person for urothelial cancer into low intermediate or high risk to determine next steps 16 To be in the low risk category one must satisfy all of the following criteria Has never smoked tobacco or smoked less than 10 pack years is a female less than 50 years old or a male less than 40 years old has 3 10 red blood cells per high power field has not had microscopic hematuria before and has no other risk factors for urothelial cancer 16 To be in the intermediate risk category one must satisfy any of the following criteria Has smoked 10 30 pack years is a female 50 59 years old or a male aged 40 59 years old has 11 25 red blood cells per high power field or was previously a low risk patient with persistent microscopic hematuria and has 3 25 red blood cells per high power field 16 To be in the high risk category one must satisfy any of the following criteria Has smoked more than 30 pack years is older than 60 years of age or has above 25 red blood cells per high power field on any urinalysis 16 For the low risk category the next step is to either repeat a urinalysis with urine microscopy in 6 months or perform a cystoscopy and renal ultrasound 16 For the intermediate risk category the next step is to perform a cystoscopy and renal ultrasound 16 For the high risk category the next step is to perform a cystoscopy and CT urogram 16 If an underlying cause for hematuria is discovered it should be managed appropriately 16 However if no underlying cause is discovered the hematuria should be re evaluated with urinalysis and urine microscopy within 12 months 16 Additionally for all risk categories if a nephrologic origin is suspected consultation of a nephrologist should be made 16 Pathophysiology editThe pathophysiology of hematuria can often be explained by damage to the structures of the urinary system including the kidney ureter urinary bladder and urethra and in men the prostate 4 1 Common mechanisms include structural disruption to the glomerular basement membrane and mechanical or chemical erosion of the mucosal surfaces of the genitourinary tract 4 Management editMedical emergency acute clot retention edit nbsp A 60cc mL Toomey syringe Fill syringe with saline Connect syringe to a catheter port Instill 180cc of saline Draw back 180cc of bladder urine Dispose of medical waste Repeat until all clots are removed Acute clot retention is one of three emergencies that can occur with hematuria 17 The other two are anemia and shock 17 Blood clots can prevent urine outflow through either ureter or the bladder 17 This is known as acute urinary retention Blood clots that remain in the bladder are digested by urinary urokinase producing fibrin fragments 17 These fibrin fragments are natural anticoagulants and promote ongoing bleeding from the urinary tract 17 Removing all blood clots prevents the formation of this natural anticoagulant 17 This in turns facilitates the cessation of bleeding from the urinary tract 17 The acute management of obstructing clots is the placement of a large 22 24 French urethral Foley catheter 17 Clots are evacuated with a Toomey syringe and saline irrigation 17 If this does not control the bleeding management should escalate to continuous bladder irrigation CBI via a three port urethral catheter 17 If both a large urethral Foley catheter and CBI fail an urgent cystoscopy in the operating room will be necessary 17 Lastly a transfusion and or a correction of a coexisting coagulopathy may be necessary 17 Medical emergency urosepsis edit Urosepsis is defined as sepsis caused by a urogenital tract infection and comprises about 25 of all sepsis cases 18 Urosepsis is the result of a systemic inflammatory response to infection and can be identified by numerous signs and symptoms e g fever hypothermia tachycardia and leukocytosis 18 Signs and symptoms that indicate a urogential tract infection is the source of the sepsis may include but are not limited to flank pain costovertebral angle tenderness pain with micturition urinary retention and scrotal pain 18 In terms of the visibility hematuria can be visible to the naked eye termed gross hematuria and may appear red or brown sometimes referred to as tea colored or it can be microscopic i e not visible to the eye but detected of urosepsis 18 In addition to imaging tests patients may be treated with antibiotics to relieve the infection and intravenous fluids to maintain cardiovascular and renal perfusion 18 Acute management of hemodynamic status in the event intravenous fluids are unsuccessful may include the use of vasopressor medications and the placement of a central venous line 18 Epidemiology editIn the United States microscopic hematuria has a prevalence of somewhere between 2 and 31 19 7 Higher rates exist in individuals older than 60 years of age and those with a current or prior history of smoking 19 Only a fraction of individuals with microhematuria are diagnosed with a urologic cancer 19 When asymptomatic populations are screened with dipstick and or microscopy medical testing about 2 to 3 of those with hematuria have a urologic malignancy 19 Routine screening is not recommended 19 7 Individuals with risk factors who undergo repeated testing have higher rates of urologic malignancies 19 These risks factors include age gt 40 years male gender previous or current smoking chemical exposure e g benzenes hydrocarbons aromatic amines history of chemotherapy alkylating agents ifosfamide prolonged foreign body in the bladder such as a bladder catheter prior pelvic radiation therapy or greater than 25 red blood cells per high powered field on urine microscopy 19 7 The prevalence of microscopic hematuria in North Africa is very high due to the high prevalence of the blood fluke schistosoma haematobium which chronically infects the urinary tract 7 In pediatric populations the prevalence is 0 5 2 20 Risks factor include older age and female gender 21 About 5 of individuals with microscopic hematuria receive a cancer diagnosis 40 of individuals with macroscopic hematuria blood easily visible in the urine receive a cancer diagnosis 22 References edit a b c d e f g h i Papadakis Maxine A McPhee Stephen J Rabow Michael W 14 September 2021 Current medical diagnosis amp treatment 2022 23 02 Hematuria ISBN 978 1 264 26938 9 OCLC 1268130534 a b Kirkpatrick Wanda G 1990 Chapter 184 Hematuria in Walker H Kenneth Hall W Dallas Hurst J Willis eds Clinical Methods The History Physical and Laboratory Examinations 3rd ed Boston Butterworths ISBN 978 0 409 90077 4 PMID 21250137 retrieved 2022 01 17 a b c d e f g h i j k l m n o Partin Alan W Dmochowski Roger R Kavoussi Louis R Peters Craig eds 2021 Evaluation and Management of Hematuria Campbell Walsh Wein urology Twelfth ed Philadelphia Pennsylvania ISBN 978 0 323 54642 3 OCLC 1130700336 a href Template Cite book html title Template Cite book cite book a CS1 maint location missing publisher link a b c d e f g h i j k l m n o p q r s Saleem Muhammad O Hamawy Karim 2022 Hematuria StatPearls Treasure Island Florida StatPearls Publishing PMID 30480952 retrieved 2022 01 17 a b c d e f g h McAninch Jack W Lue Tom 2013 Chapter 3 Symptoms of Disorders of the Genitourinary Tract Smith amp Tanagho s General Urology McGraw Hill Education a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae Stern Scott D C Symptom to diagnosis an evidence based guide Chapter 21 1 Approach to the Patient with Hematuria Case 1 OCLC 1121597721 a b c d e f Ingelfinger Julie R 8 July 2021 Hematuria in Adults New England Journal of Medicine 385 2 153 163 doi 10 1056 NEJMra1604481 Hashmi Mydah S Pandey Jyotsna 2022 Nephritic Syndrome StatPearls Treasure Island Florida StatPearls Publishing PMID 32965911 retrieved 2022 01 19 Izzo Joseph L Sica Domenic A Black Henry Richard 2008 Hypertension Primer Lippincott Williams amp Wilkins p 382 ISBN 978 0 7817 8205 0 Changes in Urine Symptoms Causes amp Treatment Cleveland Clinic Retrieved 2022 09 12 Hematuria in Children National Kidney Foundation 2015 12 24 Retrieved 2023 03 11 Pade Kathryn H Liu Deborah R September 2014 An evidence based approach to the management of hematuria in children in the emergency department Pediatric Emergency Medicine Practice 11 9 1 13 quiz 14 ISSN 1549 9650 PMID 25296518 a b Avellino Gabriella J Bose Sanchita Wang David S June 2016 Diagnosis and Management of Hematuria Surgical Clinics of North America 96 3 503 515 doi 10 1016 j suc 2016 02 007 PMID 27261791 a b Yun Edward J Meng Maxwell V Carroll Peter R March 2004 Evaluation of the patient with hematuria Medical Clinics of North America 88 2 329 343 doi 10 1016 S0025 7125 03 00172 X PMID 15049581 a b c Davis Rodney Jones J Stephen Barocas Daniel A Castle Erik P Lang Erich K Leveillee Raymond J Messing Edward M Miller Scott D Peterson Andrew C Turk Thomas M T Weitzel William 2012 12 01 Diagnosis Evaluation and Follow Up of Asymptomatic Microhematuria AMH in Adults AUA Guideline Journal of Urology 188 6S published 2012 2473 2481 doi 10 1016 j juro 2012 09 078 PMID 23098784 a b c d e f g h i j Barocas Daniel A Boorjian Stephen A Alvarez Ronald D Downs Tracy M Gross Cary P Hamilton Blake D Kobashi Kathleen C Lipman Robert R Lotan Yair Ng Casey K Nielsen Matthew E 2020 10 01 Microhematuria AUA SUFU Guideline Journal of Urology 204 4 778 786 doi 10 1097 JU 0000000000001297 PMID 32698717 S2CID 220717643 a b c d e f g h i j k l Kaplan Damara Kohn Taylor Urologic Emergencies Gross Hematuria with Clot Retention American Urological Association Archived from the original on 2019 11 28 Retrieved 2019 12 11 a b c d e f Wagenlehner Florian M E Lichtenstern Christoph Rolfes Caroline Mayer Konstantin Uhle Florian Weidner Wolfgang Weigand Markus A June 2013 Diagnosis and management for urosepsis Items in urosepsis International Journal of Urology 20 10 963 970 doi 10 1111 iju 12200 PMID 23714209 a b c d e f g Coplen D E January 2013 Diagnosis Evaluation and Follow Up of Asymptomatic Microhematuria AMH in Adults AUA Guideline Yearbook of Urology 2013 1 2 doi 10 1016 j yuro 2013 07 019 ISSN 0084 4071 Shah Samir Ronan Jeanine C Alverson Brian 2014 Step up to pediatrics first ed Philadelphia Wolters Kluwer Lippincott Williams amp Wilkins pp 175 176 ISBN 978 1451145809 OCLC 855779297 Cohen Robert A Brown Robert S 2003 06 05 Clinical practice Microscopic hematuria The New England Journal of Medicine 348 23 2330 2338 doi 10 1056 NEJMcp012694 ISSN 1533 4406 PMID 12788998 Sharp Victoria Barnes Kerri D Erickson Bradley D December 1 2013 Assessment of Asymptomatic Microscopic Hematuria in Adults American Family Physician 88 11 747 754 PMID 24364522 External links edit nbsp Media related to Hematuria at Wikimedia Commons Retrieved from https en wikipedia org w index php title Hematuria amp oldid 1221659793, wikipedia, wiki, book, books, library,

article

, read, download, free, free download, mp3, video, mp4, 3gp, jpg, jpeg, gif, png, picture, music, song, movie, book, game, games.