Hematuria - blood in the urine, as a symptom of dangerous diseases. Hematuria - blood in the urine when urinating

Sometimes to understand that something is wrong with the body, only the results of the tests will help. A blood test will allow you to assess the general condition of the body, and urine tests can be used to judge the state of the urinary system. Particular attention should be paid to the presence in the urine of erythrocytes - red blood cells.

Hematuria - what is it?

The appearance of blood in the urine is called hematuria. It is not at all necessary that the patient will notice with the naked eye the presence of blood cells in the analysis, hematuria can proceed unnoticed and be revealed only at the doctor's appointment.

By itself, hematuria is not considered a disease, it is only a symptom of the pathology of the urinary tract.

Despite this, in the international classification of diseases, hematuria has its own ICD-10 codes:

• N02 - recurrent and persistent hematuria;
• R31 - nonspecific hematuria.

In a completely healthy person, a urine test may contain a certain number of red blood cells - no more than 1-2 in the field of view, an increased number of red blood cells will already indicate the presence of hematuria.

If there is a significant amount of blood in the urine, which is visible to the naked eye, they speak of gross hematuria, and this is evidence of a serious urological disease.

Sometimes it happens that the appearance of red blood cells in the urine in women may be due to careless collection of analysis on critical days. In this case, we are not talking about hematuria.

In any case, the appearance of blood in urine tests, both in adults and in children or newborns, is considered a threatening symptom and requires additional examination.

What is hematuria

Classification

Specialists classify hematuria according to several criteria:

• the number of red blood cells in the urine;
• source of bleeding
• development mechanism;
• place of occurrence;
• clinical manifestations;
• duration.

By the number of erythrocytes, microhematuria is distinguished, in which the number of red blood cells in the urine is not so numerous that it is possible to visually assess the presence of blood in the urine, and macrohematuria, in which there is so much blood in the secretions that the color of the urine may change to brown or black.
On the video about what microhematuria is:

Depending on the source, hematuria is divided into:

• initial (initial). In this type, the initial portion of urine is stained with blood, which may be associated with bleeding from the urethra;
• terminal (terminal). With this type of hematuria, no blood is observed in the first portions of the urine, and only the last part of the urine contains blood. Often, terminal hematuria accompanies various lesions of the bladder neck or prostate gland;
• total - all urine is completely stained with blood. Total hematuria is observed when the parenchyma of the kidneys, its pelvis, bladder or ureter is damaged.

This division will help the doctor in the study to suggest in which part of the urinary system the pathology has arisen.

According to the mechanism of development, there are:

• extrarenal type. This type is said in the case when hematuria does not occur due to damage to the kidney;
• Idiopathic - arose for the first time. Often found in pregnant women, due to hormonal changes or mechanical damage due to the effect of the fetus on the kidneys and urinary tract.
• renal type - associated exclusively with renal pathology;
• postrenal hematuria - bleeding originates as a result of pathological processes in the bladder.

Depending on the place of occurrence, hematuria is divided into:

• glomerular, when blood enters the urine through the glomeruli of the kidney. Lasts quite a long time, almost always has a total form, is usually accompanied by the presence of protein in the urine;
• postglomerular - the source of bleeding is located near the glomerular filter.

According to the duration, hematuria is divided into three types:

• short-term - observed during the passage of stones;
• persistent - hematuria persists for a long time, sometimes even several years;
• asymptomatic (painless) - observed in some congenital kidney diseases;
• intermittent - hematuria is intermittent, periodic. It is observed with injuries, immunoglobulin nephropathy, Berger's disease.

According to the clinical features of the course of the disease, experts distinguish:

• isolated hematuria - the occurrence of only bleeding that is not combined with other signs of the disease;
• associated with proteinuria;
• recurrent hematuria;
• essential - this is the name of the form of hematuria, in which it is impossible to reliably determine the cause of the pathological condition. At present, if the diagnostician has modern equipment, the term is considered obsolete and is practically not used.

The reasons

In a healthy person, hematuria is practically not observed. It is extremely rare for people who make long hikes or sprinters after running long distances to have such conditions. As a rule, at the end of the load, the condition improves on its own. In such cases, experts note microhematuria.

As for gross hematuria, it is always evidence of severe damage to the kidneys or urinary system.

Conventionally, there are several reasons that can cause the appearance of red blood in the urine:

• injuries to the lower abdomen or back in the kidney area;
• medication (medicated hematuria);
• kidney disease - both hereditary and acquired;
• oncological diseases of internal organs.

If we take into account hematuria of non-renal origin, then most often hematuria is a consequence of the formation and movement of stones along the urinary tract.

The second, no less common cause of hematuria is the intake of certain medications, in particular anticoagulants or drugs taken during chemotherapy by cancer patients.

The cause of hematuria in men can be diseases of the prostate gland:

• prostatitis;
• cancer tumor;
• BPH.

If we talk about renal hematuria, then its causes may be:

1. Injuries and wounds of the kidneys.
2. Stone formation and passage of stones.
3. tumor processes. The appearance of blood clots in the urine should alert the patient and serves as a signal for urgent medical attention.
4. Inflammatory and infectious diseases of the kidneys.
5. Hereditary and in newborns.

Sometimes the causes of blood in the urine are inflammatory and infectious diseases of the body that are not associated with the urinary system: sepsis, measles, scarlet fever, rheumatism, etc.

Diagram showing possible causes of hematuria

Symptoms

Speaking of symptoms, it should be noted that hematuria is not a separate disease, but in itself serves as a symptom of a disease. Therefore, we should only talk about the accompanying complaints of patients indicating one or another reason that causes an increase in red blood cells in the urine test.

Most often, patients complain of such sensations:

• pain in the lumbar region or in the side, which vanishes about damage to the kidneys, which indicates damage to the kidneys;
• pain during urination, before it or immediately after emptying the bladder;
• thirst;
• severe weakness and dizziness;
• pain in the lower abdomen;
• the appearance of blood clots in the urine, which may indicate the presence of renal bleeding;
• inability to completely empty the bladder, frequent urge to urinate;
• the appearance in the urine along with blood of small stones or sand, which indicates urolithiasis.

Diagnostics

To diagnose the disease that causes hematuria, you should immediately contact a urologist. First of all, if hematuria is suspected, the doctor will prescribe a urinalysis, which will show whether the patient actually suffers from hematuria or if urine staining in red is due to other reasons.

A urinalysis given by the patient will show if there is an increased number of red blood cells in the urine, if there is proteinuria, if there are salts in the test sample that can cause stone formation, or bacteria that can cause inflammatory kidney disease.

In addition to a urinalysis, your doctor will likely order the following tests:

• blood test for creatinine content;
• radiography of the abdominal cavity;
• ultrasound examination of the kidneys and bladder;
• intravenous pyelography, which gives a complete picture of the pathologies of the urinary system;
• cystoscopy - endoscopic examination of the bladder;
• MRI or CT scan of the abdomen;
• a three-glass urine sample to determine which of the portions of urine contains blood. In this case, the doctor will determine whether the hematuria is initial, terminal or total, which will suggest in which of the sections of the urinary system there is a pathological process.

Treatment

To get rid of such a symptom as hematuria, it is necessary to identify a disease that causes the appearance of red blood cells in the urine.

In case of infection of the urinary tract or bladder, the patient will be prescribed antibiotic therapy.

If the patient has stones in the kidneys or ureter, then the therapy will be aimed at the rapid passage of the stone from the urinary tract, and if the stone cannot be removed, the patient will need surgery.

In case of kidney injuries, the patient is shown urgent surgical intervention.

To stop bleeding with gross hematuria, the doctor may prescribe hemostatic drugs, and if the blood loss is more than 500 ml, infusion therapy will be needed.

In any case, a patient who is diagnosed with hematuria should immediately undergo all the examinations prescribed by the doctor and immediately begin treatment. This formidable symptom should never be ignored!

Hematuria is a disease characterized by the appearance of red blood cells (erythrocytes) in the urine. In this case, a change in the color of urine to dark or reddish-brown is observed. If the number of red blood cells exceeds the norm slightly, which can only be detected with the help of tests, then this is a mild form of the disease - microhematuria. If the urine differs significantly in color from normal, and blood clots can be visually determined, then this is a more serious form - gross hematuria. This disease affects men who are engaged in heavy physical exertion, which can affect the kidneys, disrupting their filtering mechanism.

A benign or malignant tumor of the genitourinary system almost always causes hematuria. Less commonly, the disease appears due to metabolic disorders or serious blood diseases.

Hematuria can occur unexpectedly without worsening the general condition of the patient and without causing pain symptoms. The painless form of the disease most often appears with tumors of the bladder.

If the blood in the urine is accompanied by pain or severe burning during urination, this indicates an incipient inflammatory process. Often the cause of hematuria is a kidney biopsy.

Types of hematuria

The disease is divided into several types:

• initial hematuria or initial - the appearance of blood only during the first urination. Such hematuria develops when the pathology is located in the back of the urethra;
• terminal hematuria or final - characterized by the appearance of blood during the last urination. This usually occurs with lesions of the bladder neck, as well as diseases of the prostate in men;
• total hematuria - complete staining of urine with blood. Occurs with serious renal lesions - kidney parenchyma, diseases of the bladder, ureter, pyelocaliceal system;
• essential hematuria - translated from Latin means essential or primary. This is an outdated term that was used for an unexplained form of the disease. Essential hematuria included bleeding occurring at the time of violation of the integrity of the fornic part of the renal calyces;
• isolated hematuria is often observed in patients with nephritis and in people suffering from alcohol dependence.

With total hematuria, the source of bleeding can appear in almost any part of the urinary system.

How is the type of disease determined?

The type of hematuria is determined using a special analysis - a three-glass sample. Morning urination of the patient occurs alternately in three containers. Each of them is signed for further study of the number of red blood cells in the laboratory. After the analysis, experts draw the appropriate conclusions. If in the first jar the number of blood cells is higher than in the others, then the patient suffers from initial hematuria, and if there is a predominance of blood in the last jar, then the hematuria is terminal. With the same number of red blood cells in all portions of urine, a diagnosis of total hematuria is made.

They also share glomerular, that is, the ingress of blood into the urine in the renal glomeruli, and non-glomerular - the ingress of blood into the urine at all other stages of urination.

According to the classification, glomerular always lasts for quite a long time, the disease has a total appearance and is accompanied by the presence of protein in the urine (proteinuria). It usually occurs as a result of heart disease, pathology of the liver, kidneys, blood and malignant tumors. Hematuria can be caused by infectious diseases, as well as taking certain medications.

Non-glomerular renal hematuria can be both initial, and terminal, and total. The amount of protein in it is so small that it can be impossible to detect during analysis.

It happens that blood in the urine is a one-time phenomenon, but, nevertheless, it indicates the development of a serious illness.

Symptoms of the disease

Differential diagnosis of hematuria reveals a number of main symptoms, among which are increased irritability during urination. This is soreness, sudden urge and stable frequency of urination. These signs indicate an inflammatory process progressing in the bladder, urethra or prostate gland.

It is necessary to conduct a bacteriological analysis of urine in time, since an infection detected in the early stages can be successfully treated. If an infectious agent is detected, the doctor prescribes a course of antibiotics.

Hematuria, accompanied by irritability during urination, often occurs in people suffering from bladder carcinoma. Carcinoma, like well-differentiated cancer of the urinary tract, is quickly detected by cytological examination of the fluid that was obtained by washing the bladder with an isotonic sodium chloride solution. Washing is done through a special catheter.

The defeat of the lower parts of the urinary tract can only be spoken about if there are symptoms of an obstructive urination disorder. That is, the thickness of the jet decreases during urination, an indefinite frequency of urges is observed, the bladder is not completely emptied.

If the patient experiences pain in the lateral parts of the abdomen, this fact indicates that the sources of bleeding in this case are the ureter or kidneys. Abdominal pain, accompanied by intestinal obstruction, is a consequence of inflammatory, kidney injury or cancer. The presence of a feverish state indicates infectious diseases of the kidneys.

Diagnosis of hematuria

To accurately determine the classification of hematuria, you need to contact a specialist. Only an experienced urologist is able to diagnose this disease. First of all, he conducts a thorough survey of the patient in order to identify possible third-party causes of hematuria. For example, this happens after eating beets, rhubarb, other foods or medicines. The doctor must also make sure that the patient does not have diseases such as scarlet fever, typhus, syphilis, hemolytic anemia, that is, all conditions in which there is a possibility of an increase in red blood cells in the urine.

It is important to know all the nuances and not confuse hematuria with another similar disease - urethrorrhagia - involuntary discharge of blood from the urethra (more common in men).

Methods of treatment

Symptoms of hematuria are at the same time symptoms of a specific, more serious disease. Therefore, all medical procedures and activities, first of all, should be aimed at recognizing the main reason, due to which the appearance of an increased level of red blood cells in the patient's urine was caused. To do this, you need to conduct a complete diagnostic examination of the body.

The success of treatment directly depends on the timing: the sooner you start fighting the disease, the better.

If the disease arose due to an infectious disease, then a course of antibacterial drugs should be prescribed. This takes into account the sensitivity of the pathogen to antibiotics.

If the cause is an inflammatory process, then, as a rule, anti-inflammatory drugs are prescribed. Often, with inflammation, treatment with folk remedies helps. The basis of treatment is the intake of diuretic decoctions.

Often the disease is treated with surgery. This need arises if polycystic disease or oncological diseases have become the root cause of the disease. Regardless of the stage and type of pathogens, a patient with hematuria is always prescribed bed rest.

Blood in the urine (hematuria) is a sign that something is causing bleeding in the genitourinary system. These can be the kidneys, the tubes that carry urine from the kidneys to the bladder (ureters), the prostate gland in men, the bladder, or the tube that carries urine from the bladder out of the body (urethra). Urine itself normally does not contain red blood cells, as filters in the kidneys prevent blood from entering the urine.

In the international classification of diseases ICD-10, hematuria has the following codes:

• Recurrent and persistent hematuria - N02.
• Nonspecific hematuria - R31.

There are two types of hematuria: microscopic and macroscopic:

• At microscopic hematuria the amount of blood in the urine is so small that human vision cannot see it. Hemorrhage can only be seen under a microscope.
• At macrohematuria urine is pink, red, brown, or dark in color and may contain small or large blood clots. They are visible to the naked eye.

There are the following types of macroscopic hematuria:

• Initial(another medical term is initial). Appears in connection with bleeding from the urethra.
• ultimate(it's also terminal). Its source is in the posterior urethra or bladder.
• Complete(total). It occurs due to bleeding in the kidneys. Sometimes urine turns dark red with blood clots. Total hematuria also happens with urolithiasis, then it appears after a painful attack.

Types of hematuria depending on the mechanism of development:

• Extrarenal type- not associated with injuries or pathologies of organs.
• Renal type- Occurs in renal disease.
• Postrenal type- occurs in diseases of the bladder and urinary tract.

In some cases, it is not possible to make an accurate diagnosis of a patient with an admixture of blood in the urine. In this case, hematuria is called essential (other terms are primary or idiopathic).

The amount of blood in the urine does not necessarily indicate the severity of the problem. Even the excretion of a small amount of blood (1 milliliter) will turn the urine red.

Reddish urine, without signs of blood, is called "pseudohematuria" or false hematuria. It can be caused by excessive consumption of beets, berries, rhubarb, food coloring, or certain drugs (such as aspirin). Also, red or reddish-brown urine can be due to myoglobin in the urine and most types of porphyria.

Signs and symptoms of hematuria

Most often, hematuria is asymptomatic. If the blood in the urine is accompanied by any sensations, this is largely the "merit" of the underlying disease that caused hematuria.

• Fever, abdominal pain, urination disorder in adults or enuresis in adolescents in conjunction with hematuria may indicate a urinary tract infection.
• Stones in the kidneys can cause symptoms such as severe pain in the abdomen and side and darkening of the color of the urine.
• Morning edema, weight gain, oliguria, dark urine, and hypertension suggest a violation of glomerular (glomerular) filtration of the kidneys. The severity of pain in hematuria of glomerular origin is minimal.
• Joint pain, skin rashes and prolonged fever in adolescents, together with hematuria, suggests collagen vascular disorders.
• Anemia in a patient with hematuria cannot be explained by blood in the urine alone. The doctor should look for other elements that indicate the underlying disease.
• Hematuria, skin rashes and arthritis may occur in systemic lupus erythematosus.

Hematuria in men, women and children occurs already with a slight increase in the number of red blood cells (more than 3) in the field of view when examining urine. Normally, a healthy person should not have hematuria.

• Severe hematuria is the presence of more than 50 erythrocytes in the field of view when considering the number of blood cells in the urine sediment.
• Moderate hematuria is the presence of 30 to 50 red blood cells per field of view.
• Insignificant hematuria - up to 10-15 erythrocytes in the field of view.

In children, hematuria has more than 100 different causes, including:

• abnormal structures in the urinary tract;
• hereditary diseases;
• mineral imbalance in the urine;
• hepatic nephropathy;
• mechanical injuries (masturbation);

Children who have microscopic hematuria with normal blood pressure and renal function should have their urine tested within a few months. If blood in the urine continues to be detected, you need to:

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• do an ultrasound of the kidneys;
• check urine for protein, calcium and creatinine;
• do a blood test to determine kidney function.

If all tests are negative, and the etiology (cause of the onset of the disease) has not been clarified, the child is scheduled for annual examinations.

Children with microscopic hematuria accompanied by high blood pressure, an abnormal blood test, a family history of kidney disease, or high levels of protein in the urine may need a kidney biopsy.

The appearance of blood in the urine in men is the most likely sign of kidney and bladder stones, injury to the kidneys, bladder, or other parts of the urinary tract.

• Often, blood impurities in the urine appear if the body is subjected to increased physical exertion. Then the kidneys are under increased pressure and they do not have time to remove metabolites. Such hematuria is called "marching" because it was first described in recruits in the army after a forced march or other physical activity.
• Less commonly, hematuria is due to prostate adenoma or as a symptom of prostate cancer in men. May occur after surgery to remove prostate adenoma (TUR, laser resection, etc.).
• Very rarely, hematuria in men is a clinical sign of Hippel-Landau syndrome, a hereditary disease in which benign neoplasms (tumors) grow on the kidneys, testicles, and spine.
• It is necessary to distinguish hematuria from the admixture of blood in the semen (hemospermia).

The most common cause of blood in the urine in women is urological (urethritis, acute cystitis and other urinary tract infections).

• Blood in the urine may appear after injections of diclofenac in the treatment of osteochondrosis or the anticoagulant warfarin.
• In pregnant and lactating women with macroscopic hematuria, urine becomes pinkish, red, brown, possibly with small blood clots.
• In addition, there may be pain in the lower back, abdomen, or genitals, accompanied by a burning sensation when urinating.
• In some cases, there may be fever or nausea with weight loss and decreased appetite.
• With microscopic hematuria, these symptoms are not present.
• The best course of action when detecting blood in the urine during pregnancy or lactation is to immediately seek help from a gynecologist clinic.

The shape of the blood clots is also important.. Worm-like clots indicate a kidney tumor, and shapeless clots indicate a bladder tumor.

Since folk remedies and antibiotic pills can "lubricate" the symptoms that accompany hematuria, they should not be taken before seeing a doctor.

Causes of hematuria, diagnostic methods and methods of treatment

Hematuria can be caused by an open fistula in the perianal area, inflammation, infection, trauma, or cancer in any part of the urinary system. In the case of hematuria, the causes that caused it may occur in the following organs:

• urinary system. Its role is to remove waste products from the body and control fluid and mineral balance. It consists of two kidneys, two ureters, bladder and urethra. Hematuria is usually a sign of a problem with one or more parts of the urinary system.
• kidneys. The cause of hematuria can be:
  • A kidney infection (pyelonephritis) in which bacteria enter the kidneys either through the bloodstream or from the ureters. In this case, blood in the urine may be accompanied by renal colic.
  • Stones in the kidneys.
  • Pathological process of renal glomeruli and vessels (kidney parenchyma). Unlike the non-glomerular form of hematuria, glomerular kidney damage is accompanied by severe proteinuria - the presence of protein in the urine test.
  • Kidney cancer. The most common type is renal cell carcinoma.
  • Injuries, such as a blow to the kidneys during an accident or sparring.
• Bladder. The occurrence of hematuria may be associated with:
  • Bladder infection. Most of these infections begin when bacteria gain access to the bladder by making their way to it through the urethra.
  • Bladder cancer.
  • Bladder stones - Minerals can crystallize in the urine in the bladder and form small stones.
• Urethra. Urethritis can be caused by the same bacteria that cause urinary tract infections and are often associated with sexually transmitted diseases, including chlamydia, gonorrhea, and the herpes virus.
• Prostate. The prostate is a small gland that sits just below the bladder and surrounds the top of the urethra. There are only men. With age, the prostate tends to grow, a condition called benign hypertrophy. The word "benign" distinguishes this condition from prostate cancer. Blood in the urine also appears due to prostate cancer.

Methods for diagnosing hematuria

Sometimes a person has no reason to worry when he finds hematuria. It can also be caused by daily activities such as intense exercise. And pseudohematuria is completely harmless. However, sometimes hematuria can indicate a serious medical condition, so you should see your doctor if you see blood in your urine.

The following symptoms are of particular concern to doctors:

• Macrohematuria.
• Persistent microscopic hematuria, especially in elderly patients.
• Age over 50 years.
• Hypertension and edema.
• Systemic symptoms (eg, fever, night sweats, weight loss).

The doctor will begin by discussing the patient's medical history and any symptoms, followed by a physical examination. During a medical examination, the doctor will check for obvious signs of damage to the body, such as bruising.

• If the patient is male, the doctor may do a digital rectal examination to determine the cause of the hematuria.
• The patient should tell the doctor about any medications they are taking, including antibiotics, vitamins, and nutritional supplements.
• You will need to have a urinalysis, which includes examining your urine under a microscope for red blood cells, minerals that cause bladder and kidney stones, and bacteria that cause urinary tract infections.
• Your doctor may order a blood test to check your creatinine levels (an indicator of kidney function) and to test for antinuclear antibodies (used to detect autoimmune diseases).

Hematuria can be assessed with one or more of the following tests:

• Abdominal radiograph: Can be used to look for causes of hematuria such as kidney or bladder stones, especially if nausea and vomiting are present. Most causes of hematuria will not be detected by x-ray and will most likely require further investigations.
• MR/CT urography: Both methods will help the doctor assess the condition of the patient's urinary tract, including the bladder, ureters, and kidneys.
• abdominal ultrasound: using this diagnostic method, you can "see" the kidneys and bladder and determine their anomalies.
• Intravenous pyelogram: X-ray examination to help the doctor visualize the kidneys, bladder, and ureters. It will help to find pathology in the genitourinary system and show how efficiently the urinary system removes waste products.

General principles for the treatment of hematuria:

• Hematuria is a symptom of the disease, not the disease itself. Thus, therapy should be directed at the process leading to hematuria. The causes that caused asymptomatic (isolated) hematuria usually do not require treatment.
• A urinary tract infection may require antibiotics such as cefazolin.
• Surgery and placement of a nephrostomy (drainage or catheter to drain urine from the kidney) may be required for certain anatomical abnormalities, such as a tumor in the pelvic cavity.
• Patients with persistent microscopic hematuria should be evaluated every 6 to 12 months to monitor for signs or symptoms suggestive of advanced renal disease.

Complications of hematuria depend on the cause of the underlying disease. The most serious complications include:

• Pyelonephritis.
• Acute myeloid leukemia.
• Aneurysm of the renal artery.
• Transitional cell carcinoma.

It is worth noting

It is impossible to prevent hematuria. But there are steps that can help reduce the risk of some of the diseases that cause this condition.

To avoid a urinary tract infection, you need to:

• Drink plenty of fluids.
• Urinate when the urge is felt (avoid stagnation of urine in the bladder for long periods of time).
• Urinate before intercourse.
• After urination, wipe with toilet paper from front to back (for women).
• Avoid feminine hygiene products that irritate the genital area.

To avoid kidney or bladder stones, it is recommended:

• Drink plenty of fluids.
• Limit salt in your diet.
• Limit your protein intake.
• Limit your intake of foods containing oxalates, such as spinach and rhubarb.

To avoid cancer (kidney or bladder), you should:

• Do not smoke.
• Maintain a healthy weight.
• Stick to a balanced diet.
• Do physical exercise regularly.
• Avoid toxic chemicals.

Hematuria is the presence of red blood cells in the urine. Normally, the content of these formed elements in urine does not exceed 1-2 in the field of view.

The increase in the number of red blood cells may increase in the morning, but normalizes in the second portion of urine (physiologically).

There is a large list of diseases in which hematuria is traced.

The main types of hematuria (adrenal, renal, postrenal)

Classification of hematuria (erythrocytes in the urine) by type:

1. Adrenal;
2. Renal;
3. Postrenal.

Renal the form of the disease appears with organic lesions of the renal parenchyma (glomerulonephritis, malignant neoplasms, nephrosis, insufficiency, polycystic).

Postrenal the form of the disease is formed in the pathology of the urinary tract and bladder (cystitis, pyelonephritis, ureteral obstruction, nephrolithiasis).

suprarenal view pathology is caused by an increase in the number of red blood cells or their excessive destruction (Wakez disease, erythremia, hemolytic anemia).

Various types of blood in the urine

According to the number of red cells found in urine, nosology is divided into the following categories:

In the first category, human urine has a red color (“meat slops”). Microhematuria in adults and children is determined by microscopic examination of urine. Visually, the color of the liquid is not changed.

Hematuria syndrome is classified according to the time of appearance of red blood cells:

1. Initial - red cells in the first portion;
2. Total - blood in all parts;
3. The final - erythrocytes in the final portion.

Microhematuria and macrohematuria

The division into stages helps to isolate the damaged part of the urinary system according to clinical symptoms. The later red blood cells appear in it, the higher the focus of inflammation is localized.

With macrohematuria, the following degrees of the disease are distinguished:

• Minor;
• moderate;
• Expressed.

An insignificant degree is noted when 10-15 erythrocytes are found in the field of view. At a moderate stage, urinary hematuria exceeds 30-50 red cells per field of view.

With severe hematuria, especially in women, more than 50 erythrocytes can be traced in the urine.

The following types of pathology are distinguished by duration:

1. Short-term - urolithiasis;
2. Intermittent - immunoglobulin nephropathy, Berger's disease;
3. Persistent - lasts several months;
4. Asymptomatic.

Characteristics of gross hematuria

A special course has hematuria that occurs with hereditary and autoimmune diseases. It can proceed according to the type of macrohematuria, then stop. With subsequent exacerbation, an intermittent form appears.

By the nature of the pathological process, the types of hematuria are:

• Initial - appears with diseases of the urethra;
• Terminal - inflammatory changes in the bladder wall;
• Total - a pathological process in the bladder, ureter, renal tubules.

Morphologically, hematuria can be divided into types according to the nature of the clots:

1. worm-like;
2. Shapeless;
3. Longitudinal.

The type of blood clots is determined by their shape and area of ​​localization. Altered red blood cells in the urine are not always formed in the kidneys. They are observed with rupture of the urinary tract, bladder. A change in the shape of red cells can be traced with a change in the osmolality of urine.

Glomerulonephritis with hemorrhagic fever leads to a change in the shape of red blood cells. Similar changes appear in kidney tuberculosis.

Glomerular hematuria of the bladder is combined with the presence of casts in the urine.

The glomerular form of the disease appears with inflammatory changes in the renal capillaries, the absence of proliferation from the side of the mesangial vessels. The exception is IgA nephropathy. With it, extrarenal symptoms are traced, accompanied by frequent urination, cutting, burning.

Actual causes of hematuric syndrome

Common causes of hematuria:

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Common symptoms of blood in the urine

Symptoms of hematuria are due to the underlying cause leading to the appearance of blood in the urine.

In most nosological forms, a pain syndrome is formed.

It has the following specific features:

• Pain in the side;
• Pain in the lower back;
• Stretching in the lower abdomen

The above symptoms occur with nephroptosis, traumatic kidney injury, inflammation of the glomeruli.

With the breakdown of red blood cells, an icteric or earthy color of the skin may occur. The cause of the pathology is hemolytic anemia, Minkowski-Choffard disease.

Chronic bleeding from the genitourinary organs leads to hematuria. In this case, a large blood clot can block the outlet of the urethra.

Modern treatment

Treatment of hematuria is based on the elimination of the causes of blood in the urine.

With a large loss of red blood cells, hemostatic procedures should be carried out immediately.

At the same time, infectious diseases are treated.

Antibacterial treatment at the initial stages is carried out with broad-spectrum drugs. To select the optimal drug, a urine culture should be done for antibiotic sensitivity.

With oncology or polycystosis, surgical treatment is performed.

An approximate scheme of emergency therapy for chronic pyelonephritis with blood in the urine:

• Installation of a ureteral stent;
• With vesicoureteral reflux, the introduction of a catheter into the bladder;
• Nephrostomy for acute urinary block;
• Antibacterial therapy with fluoroquinolones (with a mild degree), cephalosporins, aminoglycosides (middle, severe stage).

Red color of urine - possible causes and evaluation of erythrocyte morphology

Indications for surgical treatment of hematuric syndrome:

1. Purulent pyelonephritis;
2. kidney failure;
3. Low efficiency of antibiotic therapy.

In infections caused by gram-negative and gram-positive bacteria, gentamicin is effective. Means is well soaked up and concentrated in urine.

Installation of a ureteral stent

When administered intramuscularly, the therapeutic concentration of substances in urine is observed after 1 hour. The antibiotic remains in the urine for 9-12 hours, which allows you to take a tablet of the drug (160 mg) per day. Gentamicin has a negative effect on the kidneys and the inner ear, so it should not be taken for a long time.

The drug is effectively absorbed in the gastrointestinal tract, distributed in body fluids.

Insertion of a catheter into the bladder

The half-life of the antibiotic is 4-7 hours. If gentamicin cannot be used, the following drugs are alternatives:

• Ofloxacin (oflo, zonocin) - 200 mg twice a day;
• Norfloxacin (norbactin, nolicin) - 400 mg twice a day;
• Ciprofloxacin - 500 mg twice.

The use of fluoroquinolones in children under 14 years of age is contraindicated.

In the antibacterial treatment of hematuria in pyelonephritis, there is an important rule - a re-examination with low efficacy of antibiotic therapy within 3 days.

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Hematuria is a medical term that refers to the presence of blood in the urine above the physiological norm.

Such a deviation is not an independent disease.

The severity of symptoms of hematuria depends on the site of bleeding. Pathology most often indicates diseases of the urinary system.

The disorder is recognized by the color of the urine. The color of urine is affected by the number of blood cells in the urine. Sometimes hematuria occurs in a latent form. Violation is detected only in the laboratory, according to the results of the analysis.

Blood changes the color of urine to characteristic shades: light brown, cherry, bright red. In addition to red blood cells, the type of disorder also affects the shade of urine.

The main thing is not to confuse hematuria with the natural staining of urine associated with the use of certain foods: beets, rhubarb, blackberries.

Color change occurs when taking vitamin complexes, a number of drugs. Manufacturers report this information in the instructions for use.

If there are no such warnings, there were no products with coloring pigments in the diet, you should consult your doctor.

Depending on the color of urine, 2 types of pathology are distinguished.

1. Gross hematuria - redness of urine, noticeable without examination.
2. Microhematuria - no color change occurs, the pathology is recognized only when examining urine under a microscope.

Macrohematuria has 3 varieties. They are distinguished by the degree of distribution of the violation.

1. Initial (initial) hematuria. Blood is released at the beginning of urination. Most often occurs with bleeding of the urethra. The reason is also in the injury of the bladder, urinary canal.
2. End (terminal) hematuria. Blood is excreted with the last portion of urine. The site of bleeding is the bladder. The reason for the release of red blood cells is tumors, ulcers, stones in this organ.
3. Complete (total) hematuria- the source of bleeding is in the kidneys. Urine is intensely colored. It contains clots. Total hematuria is a sign of an inflammatory process in the kidneys. For example, pyelonephritis, necropapillitis. The patient needs urgent medical attention. Otherwise, the diseases become life-threatening.

A quick urinalysis using test strips does not distinguish between the type of abnormality. Using the method, it is impossible to distinguish between the presence of erythrocytes and hemoglobin.

In connection with the source of blood loss, the violation is divided into 2 types.

1. Glomerular hematuria. With it, the blood cells passing through the basement membrane of the capillaries of the glomerulus are damaged. Unlike ordinary red blood cells, they have an irregular shape, different sizes and a smaller volume.
2. Postglomerular hematuria. Erythrocytes do not change their structure, because the focus of bleeding is located near the urethra. It is not necessary to squeeze through the membrane, so their anatomical shape remains unchanged.

According to the origin of the symptom, several types of disorders are distinguished.

1. Extrarenal hematuria. The symptom is not associated with diseases of the urinary system. Hematuria occurs against the background of diseases of the circulatory system, autoimmune pathologies.
2. Renal hematuria. With this type of pathology, the appearance of blood in the urine is associated with kidney disease.
3. Postrenal hematuria. Pathology is associated with organs located below the kidneys. For example, tumors, stones, mechanical damage.