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Hematuria

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Topics

Definition – Blood in urine. It’s either microscopic or macroscopic.

Types of hematuria

1. Microscopic: Urine appears normal, blood can be discovered on “dipstick” testing. Or, Microscopy of midstream urine (MSU) specimen: by finding > 3 RBCs / HPF of spun urine.

2.Macroscopic: frank – gross: Pink, red, or tea-colored urine. Always abnormal.

  • Isolated hematuria on dipstick testing of urine can occur in normal people.
  • Hematuria is often episodic rather than persistent, whatever the cause.
  • Age-related causes: Glomerular causes predominate in children and young adults. < 5% of cases of hematuria in patients age > 40 result from glomerular lesions.

Etiology

A. Kidney: Examples

  1. Congenital Polycystic kidney.
  2. Traumatic Ruptured kidney Stone.
  3. Inflammatory TB., Goodpasture’s synd.
  4. Neoplastic Wilm’s tumor: in kids. Renal Cell Ca. – Ca of renal pelvis.
  5. Blood disorders – Anti-coagulants, Purpura, Sickle-cell disease, Hemophilia, Malaria (blackwater fever).
  6. Congestion Right Heart Failure (RHF).
  7. Infarction Arterial emboli from MI or SBE.

B.Ureter: Stone,Neoplasm.

C.Bladder: Examples

  1. Traumatic Stone.
  2. Inflammatory: Non-specific cystitis or ulceration, TB. Schistosomiasis (S. haematobium).
  3. Neoplastic Ca.

D. Prostate: Benign / malignant enlargement urethra is obstructed straining at micturition bleeding from dilated veins at bladder neck.

E. Urethra: Examples

  1. Traumatic Rupture, Stone.
  2. Inflammatory: Acute urethritis.
  3. Neoplastic Transitional cell Ca.

N.B. Important points:

Tumors are the commonest cause of frank and microscopic hematuria, and must be suspected even if another possible cause is found.

Keep in mind that hematuria is:

Painful in:*

  1. Kidney stones: irritation from stones may also cause bleeding, but a/w pain.
  2. UTI: irritation from infection may also cause bleeding, but a/w pain.
  3. Papillary necrosis.

Painless in:*

  1. Infection.
  2. Cancer of urinary tract.
  3. Acute glomerulonephritis (GN).
  4. Contamination during menstruation.

Enlarged kidneys are more susceptible to trauma, whatever the primary pathology. In hydronephrosis/poly-cystic kidneys, minor blunt trauma may cause gross hematuria.



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