1.What is hematuria?
Hematuria is the excretion of more than normal red blood cells in the urine. Urine with normal appearance, but microscopic examination meets the diagnostic criteria is called microscopic hematuria; if 1 ml of blood is contained in each liter of urine, the color of the appearance of urine will change called carnal hematuria. Most of the corpuscular hematuria is light red or washed water-like, and even contains blood clots. Normal urine does not see red blood cells under the microscope or occasionally see red blood cells, take 10 ml of fresh urine (preferably mid-morning urine), centrifuge the sediment and take the sediment for microscopic examination, such as per high magnification field, 3 red blood cells, or Addis count (i.e. 12-hour urine sediment red blood cell count) > 500,000 can also be diagnosed as hematuria. When the urine is alkaline, hematuria is bright red. When the urine is acidic, hematuria can be coffee-colored, reddish-brown, strong tea-colored or soy sauce-colored, at which time the appearance is similar to that of hemoglobinuria and should be differentiated.
2.How to diagnose hematuria?
(1) Hematuria of the naked eye.
If the amount of hematuria exceeds lml/L, it may appear as carnal hematuria, which is generally washed water-like. When the urine is acidic, it can be coffee-colored, red-brown or tea-colored; when the urine is alkaline, it is bright red. Carnal hematuria mostly has urinary system diseases.
(2) Microscopic hematuria.
Normal urine appearance, 3 times in 1~2 weeks, the number of red blood cells in urine exceeds the normal value range, i.e., ≥3/HPF or ≥8000/ml in centrifugal urine, 12-hour urine sediment red blood cell count (Addis count) >500,000/12h, can be diagnosed as microscopic hematuria. In recent years, the 1h urine erythrocyte count method is advocated, the method is to urinate at five o’clock in the morning, and drink 200ml of water, accurately collect the child’s urine from 5 to 8 o’clock for 3h, immediately centrifugal sedimentation count erythrocytes, the number obtained is converted according to 1h, if the erythrocytes > 100,000, can be diagnosed, if the erythrocytes between 30,000 ~ 100,000 / h, is suspicious, should be combined with clinical considerations.
(3) Occult blood positive hematuria.
No red blood cells are found in the urine, but the urine is positive for occult blood, indicating the lysis of red blood cells into hemoglobinuria.
(4) Etiological diagnosis.
The etiology of hematuria is complex and involves a wide range of diseases; therefore, the key aspect of diagnosis is to determine glomerular and non-glomerular hematuria. A number of clinical tests such as urine triple cup test, urine red blood cell morphology, urine mean red blood cell volume (MCV), urine sediment red blood cell tubular pattern, urine protein, urine immunoglobulin granule tubular pattern, urine calcium, urine bacterial culture and urine exfoliative cytology can be selected to establish the etiological diagnosis. Ultrasound of both kidneys, ureter and bladder, abdominal plain film, intravenous pyelogram, cystoscopy, CT, MRI and serum immunological tests (such as anti-nuclear antibody, anti-double-stranded DNA antibody, serum complement, anti-basement membrane antibody, immunoglobulin level, etc.) should be done if necessary to aid in the diagnosis. One of the most commonly used is identification by urine red blood cell morphology.
3.What diseases are commonly associated with hematuria? How is it identified?
The causes of hematuria are commonly found in three major diseases: systemic diseases, diseases of the organs adjacent to the urinary tract, and diseases of the kidney and urinary tract.
(1) First of all, it should be determined whether it is true hematuria or pseudohematuria, and only after excluding pseudohematuria can it be diagnosed as true hematuria. Pseudohematuria is commonly seen in children due to the consumption of artificially colored foods, food or drugs such as rhubarb, rifampin and phenytoin sodium. In addition, hemoglobinuria, myoglobinuria or porphyriuria can also make the urine red in color.
(2) To determine glomerular or non-glomerular hematuria, glomerular hematuria originates from the glomerulus and non-glomerular hematuria from the calyces, renal pelvis, ureter, bladder and urethra. Urinary red blood cell morphology is commonly used for differentiation.
Glomerular hematuria, whether acute nephritis, chronic nephritis, IGA nephropathy, nephrotic syndrome, purpura nephritis, lupus nephritis, etc., can be seen, and can be clinically differentiated based on history, symptoms, signs and laboratory tests. In addition, there are hereditary kidney diseases can also be seen hematuria. For example, thin basement membrane nephropathy, which often has a family history of persistent microscopic hematuria and mild proteinuria, but renal function can be normal for a long time. .
Non-glomerular hematuria, such as systemic severe infections (sepsis, epidemic hemorrhagic fever, etc.), urinary tract infections, urinary stones, renal tuberculosis, polycystic kidney, urinary tract tumors, etc.
The clinical manifestations of urinary tract infection are symptoms of infection poisoning local symptoms are bladder irritation urine routine examination has a large number of pus cells or a large number of leukocytes pus cell tubular and leukocyte tubular have some specificity urine culture can find the causative organism antibiotic treatment is generally not easily confused with nephritis.
In the advanced stage of renal tuberculosis, the entire urinary system is involved. The possibility of renal tuberculosis should be considered in cases of persistent pyuria and should be confirmed by further bacteriological examination.
When the stone is active, it cuts through the mucous membrane and results in microscopic or visual hematuria, which is accompanied by colic pain.
The common cause of naked eye or microscopic hematuria is tumor. Kidney cancer is characterized by painless complete hematuria.
In addition, nutcracker phenomenon, also known as left renal vein compression syndrome, is one of the common causes of non-renal hematuria in children. It is a clinical condition caused by compression of the left renal vein during its journey into the inferior vena cava due to the angle formed between the abdominal aorta and the superior mesenteric artery. The diagnosis is often made clinically with the help of ultrasound, and the diagnostic criteria are: the proximal internal diameter of the dilated site before left renal vein stenosis in the supine position is more than 3 times wider than the internal diameter of the stenosis, and after 15-20 minutes in the posterior spinal extension position, the internal diameter of the dilated site is more than 4 times wider than the internal diameter of the stenosis, and the diagnosis can be made by taking two positions. Comprehensive index can also be used, that is, in addition to the above performance, plus after 15-20 minutes of posterior spinal extension, the blood flow velocity of the proximal end of the dilated left renal vein is ≤0.09m/s, and the angle between the superior mesenteric artery and the abdominal aorta is within 9 degrees as the reference value.
4, hematuria should choose those tests?
(1) Physical examination by a physician.
In addition to the general physical examination, the urinary system should be the focus of physical examination. renal area pressure pain percussion pain upper ureteral pressure pain point renal duplex examination, etc.
(2) Laboratory tests.
In addition to routine urinalysis, which is the most common and most important test, attention should be paid to the examination of renal function. The red blood cells filtered through the glomerulus are often deformed in order to be filtered out, and can show sanger-shaped, spindle-shaped, folded, polygonal, triangular-shaped deformed red blood cells generally account for more than 85%; red blood cells that do not pass through the glomerulus are often discharged in their original form, and sometimes they only show crumpled red blood cells due to intracellular dehydration, unlike deformed red blood cells.
(3) Instrumental examinations.
Ultrasound: useful for diagnosing the size and contour of the kidney, hydronephrosis, dilated upper ureter, stones, tumors, and nutcracker phenomenon polycystic kidney; the diameter of the left renal vein on the left side of the abdominal aorta is more than one times wider than that of the left renal vein in front of the abdominal aorta in the nutcracker phenomenon CT and MRI examinations: mainly used for the diagnosis of tumors stones nodules Cystoscopy: useful for diagnosing bladder tuberculosis, tumors stones, ulcers Due to impaired renal function If intravenous cystogram cannot be performed, retrograde cystogram can be performed at the same time as cystoscopy to determine the site and cause of the obstruction Renal biopsy: necessary to determine the cause and nature of substantial renal disease
5.Western medical treatment
The etiology of hematuria is complex and involves many diseases, so its treatment should be mainly directed at the etiology.
General methods:Those who have serious blood in urine should rest in bed, and antispasmodics can be given if there is renal colic.
Non-renal hematuria can be treated with hemostatic agents: in order to improve capillary permeability and shorten the bleeding time and play a hemostatic role, a large amount of vitamin C, rutin, and anilox blood can be used. Anti-fibrinolytic drugs can be used such as 6-aminohexanoic acid, anti-fibrinolytic aromatic acid and hemagglutinin, but they have the disadvantage of blocking the urinary tract with blood clots and must be used with caution.
Severe blood in urine, drug treatment is ineffective, to find the primary cause of the disease, the cause of treatment.
6. Chinese medicine single prescription therapy
White foxglove soup: 30-60g of white foxglove, decoction in water as tea. Used for all types of blood in urine.
Hemostasis formula: 12g of white foxglove root, 15g of fried gardenia, 6g of small thistle, decoction in water, taken 3 times a day. Used for actual evidence of all types of blood in urine.
Diyu Tang: 15g of Diyu, 20g of Radix Rehmanniae, 30g of Radix Bupleurum, decoction in water. Used for actual evidence of blood in urine.
Shepherd’s Purse Soup: 30-60g of Shepherd’s Purse, decoction with water. Indicated for yin deficiency of blood in urine.
Shepherd’s purse and raw earth soup: Take 30g of shepherd’s purse and 12g of raw earth in a decoction. It is suitable for yin deficiency urine and blood such as heat in the heart of the hands and feet, flushed cheeks and dry stools.
Bamboo leaf tea drink: 15g of plantain, 10g of bamboo leaf heart, 6g of maitake, decoction tea drink. It is used for blood in urine caused by heat in the bladder.
Cyperus rotundus soup: Take 30g of Cyperus rotundus in a decoction. Indicated for hematuria with small blood clots and other bruises of blood in urine.
Black fungus 30g, yellow fungus 120g, 5 bowls of water, decoction into 2 bowls, for 1 day, divided into 2 doses. It is suitable for those who have blood in urine from stasis gonorrhea.
3-6g of amber powder, decocted with lantern grass and peppermint, and mixed with soup once daily. For hematuria with stone gonorrhea.
Bitter Ginseng Decoction: 6g of Bitter Ginseng, 10g of Phellodendron, 30g of Radix Bupleurum. Clearing heat and removing dampness, cooling the blood and stopping bleeding.
7.Care and regulation
(1) During carnal hematuria, pay attention to psychological care, eliminate the child’s fear of disease, avoid emotional excitement, and maintain a calm mood.
(2) Pay attention to the change of urine color and the presence or absence of blood clots when urinating blood, and record the urine volume.
(3) Pay attention to hygiene, do not sit and lie on wet ground, change underwear regularly and keep the urethra clean.
(4) Promptly treat colds, sores, purpura and other diseases.
(5) Moderate diet, avoid excessive consumption of spicy and fatty products.
(6) Patients with blood in urine should pay attention to rest, avoid strenuous activities, and those with large amounts of blood in urine should rest in bed.
(7) It is advisable to have a light diet and avoid spicy and hot products. For allergic patients, avoid eating shrimp, crab, fish and so on.
(8) Avoid unnecessary catheterization and traumatic urinary tract examination to reduce the occurrence of hematuria.