Etiology
1.Kidney and urinary tract diseases
(1) Inflammation: acute and chronic glomerulonephritis, acute and chronic pyelonephritis, cystitis, urethritis, urinary tuberculosis, mycobacterial infections of the urinary system, etc.
(2) Stones: stones in any part of the urinary system can easily cause hematuria and secondary infections when the stones cut through the uroepithelium when moving.
(3) Tumors: Tumors in any part of the urinary system or malignant tumors in adjacent organs invading the urinary tract can cause hematuria to occur.
(4) Trauma: This refers to violence and injury to the urinary system.
(5) Drug stimulation: such as sulfonamide, phenol, mercury, lead, arsenic poisoning, massive infusion of mannitol, glycerol, etc.
(6) Congenital malformations: polycystic kidney, congenital ultra-thin glomerular basement membrane. Nutcracker phenomenon, the disease is a congenital malformation of blood vessels caused by the extrusion of the left renal vein that travels between the abdominal aorta and superior mesenteric artery, causing persistent microscopic hematuria called nutcracker phenomenon. The right renal vein injects directly into the inferior vena cava, while the left renal vein must cross the angle formed by the abdominal aorta and superior mesenteric artery to inject into the inferior vena cava. Normally, this angle is 45°~60°, but if this angle is congenitally too small or filled with mesenteric fat, enlarged lymph nodes or peritoneum, it can cause nutcracker phenomenon. Diagnosis is based on CT, ultrasound, and renal venography. Treatment must be surgically corrected.
2.Systemic diseases
(1) Hemorrhagic diseases: thrombocytopenic purpura, allergic purpura, hemophilia, leukemia, malignant histiocytosis, aplastic anemia, etc.
(2) Connective tissue diseases: systemic lupus erythematosus, dermatomyositis, polyarteritis nodosa, scleroderma, etc. .
(3) Infectious diseases: leptospirosis, epidemic hemorrhagic fever, filariasis, infectious bacterial endocarditis, scarlet fever, etc.
(4) Cardiovascular diseases: congestive heart failure, renal embolism, renal vein thrombosis.
(5) Endocrine metabolic diseases: gouty kidney, diabetic nephropathy, parathyroid dysfunction.
3.Drug-induced
Aminoglycoside antibiotics (such as gentamicin, kanamycin, tobramycin, etc.), sulfonamides (such as cotrimoxazole, etc.), cephalosporins (such as Pioneer IV, etc.) can cause nephrotoxic damage, hematuria, cephalosporins if combined with aminoglycosides or diuretics, nephrotoxicity is greater. Other drugs such as aspirin and cold pass can also cause hematuria.
Clinical manifestations
1.Change of urine color
The main manifestation of hematuria is the change of urine color, except for microscopic hematuria, which has normal color, and naked eye hematuria, which has different color according to the amount of bleeding. When the bleeding is serious, the urine can be blood-like. When the kidney bleeds, the urine is evenly mixed with blood, and the urine is dark red; when the bladder or prostate bleeds, the urine is bright red, and sometimes there are blood clots. However, red urine is not necessarily blood urine and needs to be carefully identified. If the urine is dark red or soy sauce colored, not cloudy without precipitation, microscopic examination without or only a few red cells, see in hemoglobinuria; brown-red or wine-colored, not cloudy, microscopic examination without red cells see in porphyriuria; taking certain drugs such as rhubarb, rifampin, or eating certain red vegetables can also discharge red urine, but microscopic examination without red cells.
2, segmental urine abnormal segmentation of the whole urine to observe the color such as urine three cups test, with three clean glasses were left in the beginning, middle and final segment of urine observation, such as the beginning segment of hematuria suggests that the lesion in the urethra; the final segment of hematuria suggests that the bleeding site in the bladder neck, the triangle or the prostate and seminal vesicle gland of the posterior urethra; three segments of urine are red that is, the whole hematuria, suggesting that hematuria from the kidneys or ureter.
3, microscopic hematuria urine color is normal, but microscopic examination can determine hematuria and can determine whether it is renal or postrenal hematuria. Microscopic red blood cells of various sizes and morphologies are glomerular hematuria, which is seen in glomerulo’nephritis. As the red blood cells leak from the glomerular basement membrane and pass through the renal tubules with different osmotic gradients, chemical and physical effects damage the red blood cell membrane and distort the hemoglobin by overflow. If the microscopic erythrocyte morphology is homogeneous and approximates that of peripheral blood, it is homogeneous hematuria. It suggests that hematuria originates from the posterior kidney and is seen in pelvic calyces, ureters, bladder and prostate lesions.
4, symptomatic hematuria hematuria is accompanied by systemic or local symptoms in patients. And the urinary symptoms are predominant. If accompanied by dull pain or colic in the kidney area, it suggests that the lesion is in the kidney. The bladder and urethra lesions are often associated with urinary frequency and urgency and difficulty in urination.
5.Asymptomatic hematuria Some patients have neither urinary tract symptoms nor systemic symptoms, which can be seen in the early stage of certain diseases, such as renal tuberculosis, renal cancer or early bladder cancer.
Accompanying symptoms
(1) Hematuria with renal colic is a characteristic of kidney or ureteral stones;
(2) Hematuria with interruption of urine flow is seen in bladder and urethral stones;
③Hematuria with thin urine flow and difficulty in urination is seen in prostatitis and prostate cancer;
④Hematuria with urinary frequency and urgency and pain is seen in cystitis and urethritis, accompanied by lumbar pain, high fever and chills is often pyelonephritis;
⑤ Hematuria with edema, hypertension, and proteinuria are seen in glomerulonephritis. nephritis;
⑥Hematuria with renal masses, unilaterally seen in tumors, hydronephrosis and renal cyst; bilateral enlargement is seen in congenital polycystic kidney, and palpable mobile kidney is seen in renal prolapse or wandering kidney;
(7) Hematuria with bleeding from skin mucosa and other sites is seen in hematological diseases and certain infectious diseases;
(8) Hematuria combined with celiac disease is seen in filariasis and chronic pyelonephritis.