Hematuria hematuria is defined as ≥3 red blood cells/HP in urine, >5 red blood cells/HP in centrifuged urine, or 12-hour urine Addis count >500,000, and is a common urinary tract symptom in pediatric patients. The causes are urinary tract inflammation, tuberculosis, stones or tumors, trauma, drugs, etc., which affect the organism very differently. In recent years, there has been an increasing trend of hematuria without obvious accompanying symptoms, mostly glomerular hematuria, which has attracted widespread attention and research.
Etiology
1.Kidney and urinary tract diseases
(1) Inflammation: acute and chronic glomerulonephritis, acute and chronic pyelonephritis, acute cystitis, urethritis, urinary tuberculosis, mycobacterial infections of the urinary system, etc.
(2) Stones: stones in the renal pelvis, ureter, bladder, urethra, any part of the stone, when the stone moves through the urethral epithelium, that is easy to cause hematuria also easy to secondary infection. Large stones can cause urinary tract obstruction and even kidney function damage.
(3) Tumor: Malignant tumor in any part of the urinary system or malignant tumor in adjacent organs invading the urinary tract can cause hematuria to occur.
(4) Trauma: It 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, nephritis. Nutcracker phenomenon, the disease is caused by congenital malformation of blood vessels that cause compression of the left renal vein traveling between the abdominal aorta and superior mesenteric artery, causing intractable 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) Bleeding disorders: thrombocytopenic violet epilepsy, allergic violet epilepsy, 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: gout kidney, diabetic nephropathy, hyperparathyroidism
(3) Neighboring organ diseases: tumors of the uterus, vagina or rectum invading the urinary tract
Complications of hematuria
Most of the diseases that cause hematuria include nephritis, urinary tract infection, hemorrhagic cystitis, urinary stones, renal tuberculosis, renal tumor, kidney and urethral injury, etc. Hematuria is one of the main symptoms of these diseases.
Symptoms
Normal urine contains a very small amount of red blood cells. Uncentrifuged urine can have 0 to 2 red blood cells per high magnification field under the microscope, and if it exceeds this number, it is considered hematuria.
Localization analysis for examination of hematuria
1, primary hematuria: hematuria is only seen at the beginning of urination, and the lesion is mostly in the urethra.
2.Terminal hematuria: hematuria occurs at the end of urination, and the lesion is mostly in the bladder triangle, bladder neck or posterior urethra.
3.Total hematuria: hematuria appears during the whole process of urination, and the bleeding site is mostly in the bladder, ureter or kidney.
The above three types of hematuria can be distinguished by the urine three-cup test.
How to count hematuria: It is an abnormal increase in the excretion of red blood cells in the urine, which is a signal that the urinary system may have a serious disease. Centrifugal precipitated urine with ≥3 red blood cells per high-powered microscopic field, or non-centrifugal urine with more than 1 or 1-hour urine red blood cell count of more than 100,000, or 12-hour urine sediment count of more than 500,000, all indicate an abnormal increase of red blood cells in the urine, then it is called hematuria. In mild cases, only microscopic increase of red blood cells is found, which is called microscopic hematuria; in severe cases, the appearance is washed water-like or contains blood clots, which is called sarcoid hematuria. Usually when there is 1mL of blood per liter of urine, it is visible to the naked eye and the urine is red or washed like flesh.
The amount of blood in the urine that exceeds the normal amount is called hematuria. If there is 1 mL of blood in 1000 mL of urine and the urine looks bloody or washed out to the naked eye, this is called hematuria to the naked eye. During routine urine examination, if there are more than 5 red blood cells in one high magnification field under the microscope, or if the 12-hour urine Edie count of red blood cells exceeds 500,000 and cannot be perceived by the naked eye, this is called microscopic hematuria.
When red urine is found, parents should not panic, but first distinguish whether it is true hematuria or pseudohematuria. Some drugs can cause red urine, such as aminopyrine, sodium phenytoin, rifampin, phenol red, etc.; they need to be distinguished from true hematuria.
Causes of hematuria
There are many causes of hematuria, including the following;
1, urinary system diseases such as various nephritis (acute glomerulonephritis, viral nephritis, genetic nephritis, purpura nephritis), stones (kidney, bladder, urethra), heart and kidney tuberculosis, various congenital malformations, trauma, tumors, etc.
2, systemic conditions such as bleeding disorders, leukemia heart failure, sepsis, vitamin C and K deficiency, hypercalciuria, neonatal outbreak, etc.
3, physical and chemical factors such as food allergy, radiation exposure, drugs, toxins, after exercise, etc. In order to clarify the cause, it is important to determine the site where hematuria occurs. The urine three cups test can be used to understand the source of hematuria in a very simple way.
Take three cups, and in one urine, take the first cup for anterior segment urine, the second cup for middle segment urine, and the third cup for posterior segment urine. If the first cup is hematuria means that the blood comes from the urethra; the third cup of hematuria is the final unhematuria, the lesion is mostly in the bladder or posterior urethra; the first cup, the second cup and the third cup are all blood-colored that is the whole hematuria, suggesting that the lesion is in the kidney or in the urinary tract above the bladder. To clarify which disease the hematuria is caused by, or based on the symptoms and physical signs, various experiences, X-rays and CT examinations, and even biopsy of the kidney can be performed to confirm the diagnosis.
Normal urine contains a very small amount of red blood cells. Uncentrifuged urine can have 0 to 2 red blood cells per high magnification field under the microscope; if it exceeds this number, it is considered hematuria.
Treatment
The cause of hematuria can be analyzed in terms of whether it is accompanied by other symptoms. Asymptomatic hematuria should first be considered as a possibility of a urinary tract tumor. Hematuria with pain, especially with colic should be considered as urinary tract stone, if it is accompanied by urinary pain and interruption of urine flow, bladder stone should be considered, if it is accompanied by obvious bladder irritation symptoms, urinary tract infection, urinary tract tuberculosis and bladder tumor are more common. In addition, a comprehensive judgment of the cause of hematuria should be made by combining the patient’s medical history, age, the color and degree of hematuria, etc.
I. Which diseases are common in hematuria
1, urinary stones: which include kidney, ureter, bladder or urethra stones.
2, genitourinary infection: such as pyelonephritis, renal tuberculosis, cystourethritis, prostatitis, etc.
3, primary nephritis: which includes acute and chronic nephritis, focal nephritis, benign acute hemorrhagic nephritis, etc.
4.Secondary nephritis: purpura nephritis, lupus nephritis, IgA nephropathy.
5, genitourinary tumors: there are kidney tumors, ureteral tumors, bladder tumors, prostate tumors, etc.
6, other urological diseases: such as renal prolapse, wandering kidney, congenital polycystic kidney, etc.
7, urological damage: damage to the kidney by various chemicals or drugs, hematuria caused by sulfonamides, etc.
Second, which renal hematuria needs early treatment
Renal hematuria refers to hematuria originating from the glomerulus, clinically manifested as simple hematuria, or hematuria with proteinuria, mostly seen in primary glomerular diseases, such as IgA nephropathy, thylakoid proliferative nephritis, focal glomerulosclerosis, renal cysts, polycystic kidney, also seen in secondary glomerular diseases such as purpura nephritis, lupus nephritis. If the treatment is incomplete, recurrent or miss-treatment, the disease cannot be effectively controlled and eventually leads to uremia. The pathogenesis of nephrogenic hematuria is currently considered by the medical community to be immune-related, i.e., the deposition of antigen-antibody complexes in the glomerular basement membrane and thylakoid region, which destroys the filtration barrier of the glomerular basement membrane and causes proliferation of thylakoid cells and thylakoid stroma, resulting in nephrogenic hematuria. Many people think that hematuria does not need to be treated. We believe that the cause of nephrogenic hematuria must be eliminated because long-term glomerular basement membrane lesions can also lead to glomerulosclerosis, which can cause kidney damage. Therefore, renal hematuria must be treated early.
Third, Chinese medicine on the art of nephrogenic indolent microscopic hematuria
Most of these diseases are caused by damage to kidney yin, internal fire, burning of yin liao, or blood leaking for a long time, and blood from the lower jiao becomes stasis, and stagnation of heat and stagnation of kidney liao can hurt kidney yin. If the condition is complicated, the hematuria will be prolonged and difficult to heal repeatedly.
Fourth, non-nephritis diseases appear hematuria characteristics and performance
1, renal tuberculosis hematuria: early in the urine only red blood cells and pus cells, followed by frequent urination, urinary urgency, painful urination and terminal hematuria, the patient often has a history of tuberculosis.
2, prostatic hyperplasia hematuria: a few patients with cystoscopic mucosal rupture vascular bleeding caused by carnal hematuria, sometimes discharge blood clots. Urinary frequency is an early symptom
3, urinary stones hematuria: bladder urethral stones have difficulty in urination, straining to urinate and hematuria, kidney and ureteral stones appear renal colic, if combined with infection, fever and chills may appear.
4.Urological tumors cause hematuria: renal pelvis tumors often have hematuria, and renal cancer hematuria is seen in 50-60% of cases. When the patient is seen, 1/4 of the kidney tumor cases are already in advanced stage. Features of hematuria: painless, intermittent hematuria throughout the whole process, sometimes abdominal arsenic mass can be palpated, accompanied by wasting and fever, etc.
Hematuria of bladder cancer: It is the first tumor in the urinary system, hematuria is seen in 90% of cases, hematuria of the naked eye accounts for 50%, hematuria characteristics: painless total hematuria, sometimes aggravated with terminal hematuria, intermittent occurrence in the interval is easy to give the patient the illusion of being cured, cystoscopy can be diagnosed.
5.Prolapsed kidney hematuria: the main symptom of back pain, labor and walking is aggravated, and disappears after lying down. There are often varying degrees of hematuria in the urine, often combined with hydronephrosis.
V. What types of hematuria are there
Hematuria is defined as the presence of blood in the urine. Doctors classify hematuria into 3 types.
(1) Visual hematuria, in which a large number of red blood cells are mixed into the urine and the urine is bright red or washed with water, which can be recognized at a glance;
(2) Microscopic hematuria, in which blood in the urine cannot be observed with the naked eye, but red blood cells can be found under a high-powered microscope;
(3) Urine occult blood positive, measured by computerized urine analyzer [urine occult blood (+) is positive], for microscopic examination found to have red blood cells.
Six, the care and health care of hematuria
1, hematuria is a serious symptom and the patient is extremely fearful. The patient should be reassured and explained that 1 to 3 ml of blood in 1000 ml of urine is hematuria of the naked eye. Blood loss is not serious.
2, usually develop the habit of drinking more water.
3.Smoke less or do not smoke, eat less stimulating food. Avoid taking: fishy and spicy, aquatic products (shrimp, crab), chili, garlic, raw onion, cilantro, dog meat, horse meat, donkey meat.
4.Actively treat inflammation of the urinary system, stones and other diseases.
5.Protective health care in the production of dyes, rubber, plastic and other tools.
6, in ordinary life and work, can not often make the bladder highly filled. Feel the urge to urinate, that is, to go to urinate, in order to reduce the urine in the bladder to stay too long.
7, pay attention to the combination of work and rest, avoid strenuous exercise.
In short: if hematuria is found, early examination, diagnosis and timely treatment; if it is difficult to be diagnosed for a while, it should be reviewed regularly at the hospital.
The relationship between hematuria and age and gender
Patients are very nervous after detecting hematuria and are eager to know from which part of the body the hematuria comes. Generally speaking, more than 95% of hematuria is caused by diseases of the urinary system itself.
In adolescents, hematuria is more common due to infectious diseases of the urinary tract, glomerular diseases, congenital urinary tract abnormalities and hypercalciuria.
In middle-aged patients, urinary tract infections, stones and bladder tumors are common.
Bladder tumors, renal and ureteral tumors are more common in men and urinary tract infections and stones in women between the ages of 40 and 60.
In men over 60 years of age, enlarged prostate, prostate cancer and urinary tract infections are more common, while in women, urinary tract infections and kidney or bladder tumors are more common.
Routine tests to confirm the diagnosis of renal hematuria
1.Tubular pattern in urine sediment, especially red blood cell tubular pattern, indicates that the bleeding comes from the renal parenchyma, mainly seen in glomerulonephritis.
2, Urine protein measurement, hematuria with more severe proteinuria is almost always a sign of glomerular hematuria.
3, Urine contains immunoglobulin in the form of granular tubular (IGM).
4, Urine red blood cell morphology, examination of urine sediment with a bitemporal microscope is currently the most common method to identify glomerular or non-glomerular hematuria. When the urinary red blood cell count >8×106/L, including anomalous red blood cells (ring-shaped, target-shaped, budding cell-shaped, etc.) >30%, it should be regarded as glomerular hematuria. Urine protein quantification >500mg/24 hours is often indicated as glomerular hematuria. If there is bleeding from the kidney, ureter, bladder or urethra (i.e. non-glomerular bleeding), the majority of the red blood cells are normal in size, and only a small percentage of them are abnormal red blood cells. If the hematuria is caused by a glomerular disorder, the majority of the red blood cells are aberrant, accounting for more than 75% of the hematuria, with varying morphology and significant differences in size.
What drugs are likely to cause hematuria
Aminoglycoside antibiotics (such as gentamicin, kanamycin, tobramycin, etc.), sulfonamides (such as cotrimoxazole, etc.), cephalosporins (such as Pioneer IV, etc.) can cause nephrotoxic damage and hematuria, and cephalosporins can be more nephrotoxic if combined with aminoglycosides or diuretics. Other drugs such as aspirin, cold pass, etc. can also cause hematuria.