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.
A. Kidney: Examples
- Congenital Polycystic kidney.
- Traumatic Ruptured kidney Stone.
- Inflammatory TB., Goodpasture’s synd.
- Neoplastic Wilm’s tumor: in kids. Renal Cell Ca. – Ca of renal pelvis.
- Blood disorders – Anti-coagulants, Purpura, Sickle-cell disease, Hemophilia, Malaria (blackwater fever).
- Congestion Right Heart Failure (RHF).
- Infarction Arterial emboli from MI or SBE.
- Traumatic Stone.
- Inflammatory: Non-specific cystitis or ulceration, TB. Schistosomiasis (S. haematobium).
- Neoplastic Ca.
D. Prostate: Benign / malignant enlargement urethra is obstructed straining at micturition bleeding from dilated veins at bladder neck.
E. Urethra: Examples
- Traumatic Rupture, Stone.
- Inflammatory: Acute urethritis.
- 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:
- Kidney stones: irritation from stones may also cause bleeding, but a/w pain.
- UTI: irritation from infection may also cause bleeding, but a/w pain.
- Papillary necrosis.
- Cancer of urinary tract.
- Acute glomerulonephritis (GN).
- 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.