The causes of hematuria are complex and should be diagnosed according to a rigorous diagnostic procedure.
1. First, it should be determined whether it is true hematuria or pseudohematuria.
Pseudohematuria can be diagnosed as true hematuria only after pseudohematuria is ruled out. Pseudohematuria is commonly seen in children due to the consumption of artificially colored foods, foods or drugs such as rhubarb, rifampin, phenytoin sodium, etc. In addition, hemoglobinuria, myoglobinuria or porphyriuria can also make the urine red in color.
2. Determination of glomerular or non-glomerular hematuria.
Glomerular hematuria originates from the glomerulus, while non-glomerular hematuria originates from the renal calyces, renal pelvis, ureter, bladder and urethra. Urine red blood cell morphology is commonly used for differentiation.
3.Further examination according to the clinical features of common diseases of glomerular and non-glomerular hematuria.
Glomerular hematuria.
Commonly acute nephritis, chronic nephritis, IgA nephropathy, nephrotic syndrome, purpura nephritis, lupus nephritis, thin basement membrane nephropathy, hereditary nephritis, etc. Clinical differentiation can be made according to medical history, symptoms, signs and laboratory tests.
Non-glomerular hematuria.
Systemic severe infection (sepsis, epidemic hemorrhagic fever, etc.), urinary tract infection, urinary tract stone, renal tuberculosis, polycystic kidney, urological tumor, left renal vein compression syndrome, etc.
Possible causes.
1. Hematuria caused by urinary tract infection.
Generally microscopic hematuria, only inflammation of the bladder triangle about l / 3 cases of carnal hematuria, clinical manifestations of urinary tract infection is the symptoms of infection poisoning local symptoms are bladder irritation symptoms urine routine examination with a large number of pus cells or a large number of leukocytes pus cell tubular and leukocyte tubular have a certain specificity, urine culture can find the causative bacteria antibiotic treatment is effective, generally not easily confused with nephritis.
2. All advanced stages of renal tuberculosis involve the entire urinary system.
There is usually microscopic or carnal hematuria, typical cases washout urine, long duration of disease, bladder irritation symptoms more obvious than general bacterial infection, extrarenal often find tuberculosis foci, general antibiotic treatment is ineffective, ultrasound, CT, IVP pyelogram examination is more helpful Typical imaging manifestations of tuberculosis on one side of the kidney contralateral hydronephrosis can be found in the urine antacid bacilli can confirm the diagnosis It is worth noting that long-standing pus urine should The possibility of renal tuberculosis should be thought of and should be confirmed by further bacteriological examination.
3. Stones.
The urinary system is prone to stone disease. When the stone is active, it cuts through the mucosa and microscopic or naked eye hematuria occurs, accompanied by colic pain is its characteristic Colic pain starts from the kidney area and radiates along the lateral abdomen to the inner thigh of the bladder Imaging examination can reveal the site, size, shape and obstruction site of the stone.
4. Tumor.
It is a common cause of naked eye or microscopic hematuria, and it is characterized by painless hematuria throughout the whole process of kidney cancer, with a high incidence in men, and bladder cancer is easily misdiagnosed as cystitis. For bladder irritation symptoms that persist for a long time in the elderly, the possibility of bladder cancer should be considered.
5. Left renal vein compression syndrome.
It is also called nutcracker phenomenon, which is one of the common causes of non-renal hematuria in children, and is a clinical symptom caused by the compression of the left renal vein during its journey into the inferior vena cava due to the angle formed between the abdominal aorta and 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 the internal diameter of the dilated site is more than 4 times wider than the internal diameter of the stenosis after 15-20 minutes in the posterior spinal extension position, and the diagnosis is made when one of these criteria is met.