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Hematuria |
Classification and external resources |
Microscopic hematuria |
ICD-10 |
N02, R31 |
ICD-9 |
599.7, 791.2 |
DiseasesDB |
19635 |
MedlinePlus |
003138 |
eMedicine |
ped/951 |
MeSH |
D006417 |
In medicine, hematuria, or haematuria, is the presence of red blood cells (erythrocytes) in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract (kidneys, ureters, urinary bladder, prostate, and urethra), ranging from trivial to lethal. If white blood cells are found in addition to red blood cells, then it is a signal of urinary tract infection.
Occasionally "hemoglobinuria" is used synonymously, although more precisely it refers only to hemoglobin in the urine.
Contents
- 1 Types
- 2 Diagnosis
- 3 Causes
- 4 References
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Types[edit]
Red discoloration of the urine can have various causes:
- Red blood cells
- Microscopic hematuria (small amounts of blood, can be seen only on urinalysis or light microscopy)
- Macroscopic hematuria (or "frank" or "gross") hematuria
- Hemoglobin (only the red pigment, not the red blood cells)
- Other pigments
- Myoglobin in myoglobinuria
- Porphyrins in porphyria
- Betanin, after eating beets
- Drugs such as Rifampicin and Phenazopyridine
Diagnosis[edit]
Acute hematuria due to trauma.
Often, the diagnosis is made on the basis of the medical history and some blood tests—especially in young people in whom the risk of malignancy is negligible and the symptoms are generally self-limiting.
Ultrasound investigation of the renal tract is often used to distinguish between various sources of bleeding. X-rays can be used to identify kidney stones, although CT scanning is more precise.
In older patients, cystoscopy with biopsy of suspected lesions is often employed to investigate for bladder cancer.
If combined with pain, it may be loin pain hematuria syndrome.[1]
Causes[edit]
The most common causes of hematuria[2] are:
- Urinary tract infection with viruses,[2] other sexually transmitted diseases (particularly in women)[2] or some bacterial species including strains of EPEC and Staphylococcus saprophyticus
- Bladder stones
- Kidney stones or ureter stones
- Benign prostatic hyperplasia, in older men, especially those over 50
Other, less common causes of hematuria include:
- IgA nephropathy ("Berger's disease") - occurs during viral infections in predisposed patients
- Trauma (e.g., a blow to the kidneys)
- Tumors and/or cancer in the urinary system,[2] for example bladder cancer or renal cell carcinoma
- Kidney diseases[2]
- Urinary Schistosomiasis (caused by Schistosoma haematobium) - a major cause for hematuria in many African and Middle-Eastern countries;
- Prostate infection or inflammation (prostatitis)[2]
Rare causes include:
- Benign familial hematuria
- Paroxysmal nocturnal hemoglobinuria - a rare disease where hemoglobin of hemolyzed cells is passed into the urine
- Sickle cell trait can precipitate large amounts of red blood cell discharge, but only a small number of individuals endure this problem
- Arteriovenous malformation of the kidney (rare, but may impress like renal cell carcinoma on scans as both are highly vascular)
- Nephritic syndrome (a condition associated with post-streptococcal and rapidly progressing glomerulonephritis)
- Fibrinoid necrosis of the Glomeruli (as a result of malignant hypertension)
- Vesical varices may rarely develop secondary to obstruction of the inferior vena cava[3]
- Allergy may rarely cause episodic gross hematuria in children [4]
- Left renal vein hypertension, also called "nutcracker phenomenon" or "nutcracker syndrome," is a rare vascular abnormality responsible for gross hematuria [5]
- Ureteral Pelvic Junction Obstruction (UPJ) is a rare condition beginning from birth in which the ureter is blocked between the kidney and bladder. This condition may cause blood in the urine [6]
- March hematuria secondary to repetitive impacts on the body, usually the feet
- Athletic nephritis secondary to strenuous exercise
- Medications can cause red discoloration of the urine, but not hematuria. Some examples include: sulfonamides, quinine, rifampin, phenytoin[2]
- Alport syndrome
References[edit]
- ^ Hebert, LA.; Nadasdy, T.; Nadasdy, G.; Agarwal, G.; Mauer, M.; Agarwal, AK.; Khabiri, H.; Nagaraja, HN. et al. (Mar 2006). "Proposed pathogenesis of idiopathic loin pain-hematuria syndrome.". Am J Kidney Dis 47 (3): 419–27. doi:10.1053/j.ajkd.2005.11.029. PMID 16490620.
- ^ a b c d e f g Hematuria Causes Original Date of Publication: 15 Jun 1998. Reviewed by: Stacy J. Childs, M.D., Stanley J. Swierzewski, III, M.D. Last Reviewed: 10 Jul 2008
- ^ Koshy, CG.; Govil, S.; Shyamkumar, NK.; Devasia, A. (Jan 2009). "Bladder varices--rare cause of painless hematuria in idiopathic retroperitoneal fibrosis.". Urology 73 (1): 58–9. doi:10.1016/j.urology.2008.06.039. PMID 18722652.
- ^ Graham, DM.; McMorris, MS.; Flynn, JT. (Nov 2002). "Episodic gross hematuria in association with allergy symptoms in a child.". Clin Nephrol 58 (5): 389–92. PMID 12425491.
- ^ Russo, D.; Minutolo, R.; Iaccarino, V.; Andreucci, M.; Capuano, A.; Savino, FA. (Sep 1998). "Gross hematuria of uncommon origin: the nutcracker syndrome.". Am J Kidney Dis 32 (3): E3. PMID 10074588.
- ^ Ureteral Pelvic Junction Obstruction (UPJ) / Ureteral Obstruction
Urinary system · Pathology · Urologic disease / Uropathy (N00–N39, 580–599)
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Abdominal |
Nephropathy/
(nephritis+
nephrosis)
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Glomerulopathy/
glomerulitis/
(glomerulonephritis+
glomerulonephrosis)
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Primarily
nephrotic
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Non-proliferative
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Minimal change · Focal segmental · Membranous
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Proliferative
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Mesangial proliferative · Endocapillary proliferative Membranoproliferative/mesangiocapillary
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By condition
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Diabetic · Amyloidosis
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Type I RPG/Type II hypersensitivity
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Goodpasture's syndrome
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Type II RPG/Type III hypersensitivity
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Post-streptococcal · Lupus (DPN) · IgA/Berger's
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Type III RPG/Pauci-immune
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Granulomatosis with polyangiitis (Wegener's) · Microscopic polyangiitis · Churg-Strauss Syndrome
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Tubulopathy/
tubulitis
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Proximal
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RTA (RTA 2) · Fanconi syndrome
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Thick ascending
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Bartter syndrome
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Distal convoluted
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Gitelman syndrome
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Collecting duct
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Liddle's syndrome · RTA (RTA 1) · Diabetes insipidus (Nephrogenic)
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Renal papilla
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Renal papillary necrosis
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Major calyx/pelvis
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Hydronephrosis · Pyonephrosis · Reflux nephropathy
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Any/all
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Acute tubular necrosis
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Interstitium
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Interstitial nephritis (Pyelonephritis, Danubian endemic familial nephropathy)
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Any/all
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General syndromes
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Renal failure (Acute renal failure, Chronic renal failure) · Uremic pericarditis · Uremia
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Vascular
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Renal artery stenosis · Renal Ischemia · Hypertensive nephropathy · Renovascular hypertension · Renal Cortical Necrosis
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Other
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Analgesic nephropathy · Renal osteodystrophy · Nephroptosis · Abderhalden-Kaufmann-Lignac syndrome
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Ureter
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Ureteritis · Ureterocele · Megaureter
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Pelvic |
Bladder
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Cystitis (Interstitial cystitis, Hunner's ulcer, Trigonitis, Hemorrhagic cystitis) · Neurogenic bladder · Bladder sphincter dyssynergia · Vesicointestinal fistula · Vesicoureteral reflux
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Urethra
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Urethritis (Non-gonococcal urethritis) · Urethral syndrome · Urethral stricture/Meatal stenosis · Urethral caruncle
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Any/all |
Obstructive uropathy · Urinary tract infection · Retroperitoneal fibrosis · Urolithiasis (Bladder stone, Kidney stone, Renal colic) · Malacoplakia · Urinary incontinence (Stress, Urge, Overflow)
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noco/acba/cong/tumr, sysi/epon, urte
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proc/itvp, drug (G4B), blte, urte
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Abnormal clinical and laboratory findings for urine / Urine test / urination disorder (R80–R82, 791)
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Red blood cells |
- Hematuria (Microscopic hematuria)
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White blood cells |
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Proteinuria |
- Albuminuria/Microalbuminuria
- Myoglobinuria
- Hemoglobinuria
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Small molecules |
- Glycosuria
- Ketonuria
- Bilirubinuria
- Hyperuricosuria/Hypouricosuria
- Aminoaciduria
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Pathogens |
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Other |
- Chyluria
- Crystalluria
- osmolality (Isosthenuria, Hypersthenuria)
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noco/acba/cong/tumr, sysi/epon, urte
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proc/itvp, drug (G4B), blte, urte
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