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 Post subject: HEMATURIA
PostPosted: 27 Apr 2018 15:38 
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Joined: 19 Dec 2017 14:21
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Hematuria and the Types of Hematuria
Hematuria refers to presence of blood in urine. Hematuria can be

• Gross, visible or macroscopic hematuria – person is able to see the blood in his urine

• Microscopic, non-visible or dipstick positive hematuria – blood (red blood cells) visible only on dipstick or microscopic examination. Not evident on gross inspection of urine

Blood in urine may originate from the kidney or the collecting system (the ureter, bladder and urethra). In many cases, the cause is harmless, but occasionally it may be due to some serious underlying disease.

Causes of Hematuria – Non-renal Causes
• Vigorous exercise
• Trauma – indwelling catheter, foreign body, accidental or sports trauma
• Sexual activity
• Endometriosis (presence of endometrium in ectopic sites) in females
• Menses (mixing of menstrual blood with urine)
• Viral illness - hepatitis
• Drugs – NSAIDs, sulfonamides, cyclophosphamide
• Blood disorders – Clotting disorders (hemophilia), sickle cell disease, anticoagulation therapy

Renal Causes
• Urinary tract infection (UTI) – bladder infection (cystitis), pyelonephritis (renal infection)prostatitis, tuberculosis, schistosomiasis
• Stone or calculi - bladder, ureteric or kidney stones (cause irritation and tear of the mucosal lining)
• Cancer – Tumor in kidney, ureter, prostate or bladder
• Renal disease – glomerulonephritis, vasculitis (blood vessel diseases), polycystic kidney

Risk Factors of hematuria
• History of recent infection – post-infectious glomerulonephritis (common in children)
• Men over 50 years (due to enlarged prostate)
• Family history of kidney disease or urinary tract stones
• Drug ingestion – aspirin, NSAIDs, penicillin, cyclophosphamide
• Strenuous exercise – especially long distance runners

Symptoms and Signs of Hematuria
• Passing red or dark brown coloured urine; usually painless and asymptomatic
• Associated symptoms such as painful urination, urgency, frequency (LUTS or lower urinary tract symptoms), fever with chills (urinary infection)
• Passage of clots in urine may be associated with pain over lower abdomen or back

Diagnosis of Cause of Hematuria
• Transient causes should be first excluded such as UTI, exercise-induced haematuria, certain foods or, rarely, myoglobinuria, and menstruation before detailed tests are undertaken.

• Once the above are excluded, a detailed history and physical examination followed by imaging and blood tests is necessary to find out the underlying cause of hematuria

History – Detailed history including family history, drug history (anticoagulants, pain killers), other associated medical conditions

Physical examination – Blood pressure, abdominal examination, digital rectal examination (to look for prostatic abnormalities), pelvic examination (in females)

Urinalysis – Even if hematuria was initially gross or diagnosed by dipstick test, it should be repeated to check if it is persistent. Urinalysis will also reveal evidence of infection and presence of minerals (causing urinary tract stones) as well as proteins

Quantification of urine protein - Urine for protein/creatinine ratio (PCR) or albumin/creatinine ratio
(ACR) on a random sample. An approximate value of the 24-hour urine protein or albumin excretion (in milligrams) is obtained by multiplying the ratio (in mg/mmol) x 10

Urine cytology – a sample of urine is centrifuged and the deposit examined microscopically for presence of abnormal cells that may suggest malignancy

Blood tests – Serum creatinine, calculated creatinine clearance, hemoglobin, clotting screen, tests to rule out autoimmune diseases if appropriate

Imaging tests – CT scan can reveal urinary tract stones, obstructions, infections, tumors, cystic changes and traumatic injuries. An MRI will demonstrate abnormalities in individual internal organs, such as the bladder or kidney.

Cystoscopy – It is performed by an urologist. A thin tube fitted with a tiny camera at one end is introduced via the urethra into the bladder to examine the interior of the bladder and urethra for signs of disease.

Renal biopsy – If kidney disease such as glomerulonephritis is suspected a renal biopsy may be done to confirm the diagnosis and plan further course of treatment. The procedure involves obtaining a sample of renal tissue and may be done by the doctor in hospital or as an outpatient procedure. The sample is sent to the pathology lab where it will be examined microscopically by the pathologist

Treatment of hematuria
Treatment aims at addressing the underlying cause. Some of these are

• Antibiotics to treat urinary tract infection (UTI)
• Medication to shrink an enlarged prostate or surgery as appropriate
• Shock wave treatment to break up and remove bladder or kidney stones
• Treatment of tumor or any other pathology as appropriate
• Occasionally no treatment may be indicated and such patients may be followed up periodically in primary care with blood pressure measurements, blood and urine tests and referred to specialists for further evaluation as appropriate or if symptoms recur
• Patients who are known to be at increased risk of bladder cancer (exposure to toxins, smoking, history of radiation treatment) should be regularly monitored under a specialist

Other causes of dark coloured urine (that may mimic hematuria and have to be considered)
• Hemoglobin - dipstick-positive but no red cells on microscopy
• Myoglobinuria
• Bilirubinuria (obstructive liver disease)
• Foods such as beetroot
• Drugs - eg, nitrofurantoin, senna, rifampicin
• Porphyria - urine darkens on standing

Hematuria – Important points to remember
• Hematuria may be visible (evident to naked eye) or microscopic (not evident to naked eye but red cells seen on microscopic or by dipstick)
• In visible hematuria, the urine may be red, brown or pink
• Less serious causes include vigorous exercise or sexual activity; serious conditions include tumor of the urinary tract, cystic renal disease, inflammatory lesions of kidney, bladder, prostate and urethra
• Most people with microscopic hematuria are asymptomatic and a detailed history and evaluation by a health professional is important
• All children with hematuria need further specialist evaluation
• Persons on anticoagulants should also be investigated further; anticoagulants provoke rather than cause hematuria
• Persons who do not need any treatment immediately should be followed up periodically under primary or specialist care
• Treatment usually depends on the underlying cause
• Research has shown that diet or nutrition has no role in causing or preventing hematuria


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 Post subject: Re: HEMATURIA
PostPosted: 11 May 2018 20:39 
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Joined: 26 Feb 2013 10:59
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I have attached a picture which gives an easy to grasp causes of Haematuria.


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