What is hematuria?
As the name implies, hematuria is when a person’s urine is mixed with blood. When there is 1 ml of blood in 1000 ml of urine, the urine can appear red or washboard-like and is called hematuria by the naked eye. The finding of 3 red blood cells per high magnification field in a routine urine test is microscopic hematuria.
Let me give you a pair of eyes to identify real and fake hematuria
Red urine does not necessarily mean that the urine is hematuria, as it can be caused by ingesting certain foods or taking certain medications. Red urine is red and transparent, no red precipitation after resting, no smoke after shaking, no red blood cells on microscopic examination, and negative occult blood test.
Teach you to identify the site of bleeding
Urethral drip: the lesion is in the anterior urethra
Primary hematuria: lesion in the urethra or bladder neck
Site of hematuria
Final hematuria: lesion in the bladder neck, triangle and posterior urethra
Complete hematuria: lesion in the bladder and above the bladder
Streaky clot: lesion from kidney, ureter
Mass: lesion from the bladder or prostate
Determine the cause of bleeding based on the symptoms accompanying hematuria
① Painless hematuria: Commonly caused by tumor
② Hematuria with back pain and abdominal pain: probably kidney and ureteral stones
③ Hematuria with frequent, urgent and painful urination: most of them are urinary tract infections.
④ Hematuria with difficulty in urination: prostate enlargement, bladder stone, urethral tumor are possible.
⑤ Hematuria with abdominal mass: upper abdomen: renal tumor, hydronephrosis, renal prolapse, polycystic kidney
Lower abdomen: urinary retention, pelvic tumor
(6) Hematuria with edema: nephritis is more likely.
(7) Hematuria with bleeding tendency: first consider hematological disease
What is exercise-related hematuria?
It refers to hematuria that is directly related to exercise and no other cause can be found. The incidence is as high as 60-80% in athletes.
①It occurs after exercise and the hematuria is proportional to the amount of exercise
②Hematuria is not accompanied by other symptoms and signs
③Biochemical, renal function and imaging tests are normal
④Hematuria disappears 1-3 days after exercise
⑤Self-limiting disease with good prognosis
Idiopathic hematuria: unexplained hematuria, about 10%.
Common causes: focal glomerular damage, vascular abnormalities, microstones, necrotizing papillitis
Systemic diseases in which hematuria commonly occurs
1.Hematological diseases: leukemia, hemophilia, aplastic anemia, thrombocytopenic purpura
2.Cardiovascular diseases: hypertension, arteriosclerosis, congestive heart failure, endocarditis, etc.
3, infectious diseases: sepsis, scarlet fever, smallpox, malaria, yellow fever, epidemic hemorrhagic fever, leptospirosis, etc.
4, collagen vascular diseases: systemic lupus erythematosus, polyarteritis nodosa, dermatomyositis, etc.
In order to identify the primary cause of hematuria, a detailed and comprehensive examination should be done, including
1.1 Physical examination: general condition, examination of the adjacent organs of the urinary tract, examination of the genitourinary system, etc.
2, 2 Laboratory examination.
3.Take fresh urine for routine examination.
4, urine three cups test: used to distinguish the source site of blood urine, (method: continuous urination in three containers, the first cup 10-15ml, the third cup 10ml)
5, urine sediment smear test: detection of bacteria, trichomonas. Urine culture: to determine non-specific infection. Urine cytology: leave fresh urine sediment for cytology, used to diagnose urinary tract tumor.
6.Prostate fluid examination: to diagnose prostatitis.
7. X-ray examination: abdominal plain film, intravenous pyelogram, renal arteriogram, etc.
8. B ultrasound examination: it can show the kidney location, morphology, stone, fluid, cyst, solid mass, bladder, prostate, etc.
9. CT, magnetic resonance.
10. Cystourethroscopy: biopsy.
11.Hematological examination: coagulation time, platelet count, prothrombin time, coagulation factor examination should be made when hematological disease is suspected.
Attention
Some people have microscopic hematuria on physical examination all year round, not good or bad, and no abnormality is found after various special examinations. This kind of hematuria is mostly benign spontaneous hematuria and does not need special treatment, only regular 3 months or half yearly outpatient routine urinalysis is needed. If there is any change in the situation, further examination is needed.