Whether it’s your usual physical exam or just watching your urine turn red, finding red blood cells in your urine can be a real surprise. Blood in urine is not a familiar ailment, and if it is diarrhea and fever and cough, no one but a small child would be the first to rush to the hospital to see a doctor. Hematuria, on the other hand, is unfamiliar to us, coming from inside the body and revealing disturbing information, so it is understandable that one would be anxious to seek medical attention. Therefore, it is helpful for patients to know a little about hematuria. After urine is filtered out from the glomerulus, it is concentrated in the renal tubules, passes through the ureter via the renal pelvis, and wanders a thousand times to the bladder. After reaching a certain volume, the bladder is pressurized and the urethra opens, so it flies straight down and never returns. This pathway is also called the urinary system, and any abnormality anywhere can cause blood in the urine. Only the incidence varies from population to population and from age to age. 1, nephritis manifested as simple hematuria (either visible to the naked eye or microscopic), without proteinuria hypertension edema, the textbook is called occult nephritis, more common in young people, but the symptoms are both light prognosis and good, here will not be verbose. 2, kidney or ureteral stones is a relatively troublesome thing, small is not worth the fight, large is not the right part can not fight, even if the fight may also be recidivism, the southern people suffer from it, the author is also very scratchy. Fortunately, it is not a big deal, can be recommended to the surgery slowly deal with. 3. Tumors of the bladder and kidneys are a problem that doctors are vigilant about. Older people over 50 years old should be very careful if there is hematuria in the naked eye, and it is a wise decision to do an ultrasound as soon as possible. The incidence of tumors in young people is so low that doctors basically do not consider this condition. 4, bacterial infections of the urinary tract often have more white blood cells in the urine, but it is very rare to see people who just show up with hematuria. The actual fact is that you can find a lot of people who are not able to get a lot of money for the purpose of the actual money. Is it worth to be afraid and worried about hematuria? In the previous article, we talked about how there is no need to panic when you find hematuria, but what tests do you have to do to know what is wrong with you? This question involves one of the simplest and most profound truths in medicine – the idea of diagnosis. I say it is simple because there are only five tests that need to be done – urine routine, red blood cell pattern, ultrasound, intravenous pyelogram, and renal puncture. But when I give students a lesson on this, they immediately face a serious face and do not dare to slacken, because this is a big problem related to the good or bad doctor. So much so that the world’s “bible” of kidney disease has a special section on how to test a patient with hematuria to save both time and money. A person who finds blood in the urine needs a routine urine test right away. If there is also urine protein, especially if it exceeds one gram per day, there is no doubt that it is nephritis. If it’s a simple hematuria, many people come to me with such a test and ask me if it’s nephritis, but frankly, we don’t know what it is at this point (unless it’s also found to have a red blood cell pattern, which is very rare). Up to this point, it’s been one trip to the hospital and cost $20. The next step is to do a urine red blood cell morphology, deformity more than 80% may be nephritis, especially those bud butchers more than 5%, such cases we call occult nephritis, this test requires the first urine in the morning, the price of 10 yuan. By now it has cost 30 dollars. If the deformity is not more than 80%, or most of them are normal, you need to do ultrasound of the kidneys and bladder. The black and white one is fine and costs 70, plus a bottle of mineral water. The 70 yuan is worth it, because most of the stones, tumors and deformities can be seen with ultrasound (bladder cancer to almost), if you do not see any abnormalities, you can basically rule out these diseases, and generally do not need CT to check a stool. At present, we have already spent 100 yuan and run to the hospital two or three times, if the source of the hematuria is still not clear, the patient is inevitably a little impatient, fortunately there is nothing sharp things into their bodies, malignant diseases such as tumors can be basically ruled out. If the ultrasound results are ambiguous, an intravenous pyelogram is needed, which is a bit painful, mainly strangling the stomach, for 150 yuan. If it is still normal, then the above tumor stone deformity can be completely ruled out. –Ah. Finally, I can breathe a sigh of relief. The patient’s heart stone falls to the ground and the question mark rises in his head. What is the problem that caused the hematuria? It is said that 20% of the patients have hematuria, and we have checked everything, but we can’t find out what’s wrong. However, at least we know that it is not a malignant disease, so we can wait and see. The order of the above process cannot be reversed, nor can they be prescribed together. The first article has already said that the rate of hematuria is more than 80%, or more than 5% of bud blister or combined with red blood cell tube type can be diagnosed as nephritis, that is, cryptogenic nephritis? The textbook says “Occult glomerulonephritis, also known as asymptomatic hematuria or (and) proteinuria, is a group of glomerulopathies in which the patient has no edema, hypertension or renal impairment, but only glomerulonephritic hematuria or (and) proteinuria. This group of diseases can be caused by multiple pathological types of primary glomerulopathies, but the pathological changes are mostly mild. Such pathological types as mild glomerulopathy, mild tegumentary hyperplastic glomerulonephritis and focal segmental glomerulonephritis are seen. According to the immunopathological manifestations, thylakoid glomerulonephritis can be divided into IgA nephropathy and non-IgA thylakoid glomerulonephritis” In other words, as long as you have simple hematuria, or simple proteinuria (of course, not too much) or both, these three conditions we can call occult nephritis. Is it too simple? Patients are often reluctant to finish. Even the doctors themselves feel retarded and want to do something more technical with a urine test. So, kidney puncture is on the agenda. To pierce or not to pierce? The standards for kidney puncture are not the same around the world, the Japanese wear more, Europe and the United States are very tight, urine protein more than 1 gram per day before the recommended puncture, the Chinese because most are self-pay patients, between the two. But for patients with simple hematuria, the value of puncture is really too small, and the author knows with his eyes closed that once you wear an IgA nephropathy, the thylakoid is a little hyperplastic, and there are one or two sclerosis or crescent. What’s the point? These things are not helpful to the treatment. Except to satisfy the curiosity of doctors and patients. Some patients are so curious that they try to find out what these things mean and what they mean, and they study them all day long as if they were holding a treasure map. Therefore, for simple hematuria, kidney puncture done to satisfy curiosity adds a psychological burden to the patient, and the result is much more than the doctor’s original intention.