What Is Gross Hematuria?

Hematuria refers to 3 red blood cells per high-power microscope field in centrifuged urine, or non-centrifuged urine for more than 1 or 1 hour urine red blood cell count more than 100,000, or 12 hours urine sediment count more than 500,000, all show red blood cells in urine Abnormal increase is a common urinary system symptom. The reasons are urinary inflammation, tuberculosis, stones or tumors, trauma, drugs, etc., which have a very large impact on the body. The milder ones only have increased red blood cells under the microscope, which is called microscopic hematuria; the severe ones are meat-washed or contain blood clots, which are called gross hematuria. Usually 1mL of blood per liter of urine is visible to the naked eye, and the urine is red or watery.

Basic Information

English name

hematuria

Visiting department

Nephrology, Urology

Multiple groups

Young people, middle-aged people

Common causes

Kidney and urinary tract diseases, systemic diseases, diseases of neighboring organs, etc.

Common symptoms

Renal colic, interrupted urinary flow, thin or difficult urination, frequent urination, etc.

Causes of hematuria

Kidney and urinary tract diseases

(1) Inflammation: acute and chronic glomerulonephritis, acute and chronic pyelonephritis, acute cystitis, urethritis, tuberculosis of the urinary system, and fungal infection of the urinary system.

(2) Stones: stones in the renal pelvis, ureter, bladder, urethra, and any part. When the stones move, they cut through the urothelial lining, which is likely to cause hematuria and secondary infection. Large stones can cause urinary tract obstruction and even kidney damage.

(3) Tumors : Malignant tumors in any part of the urinary system or adjacent organs can cause hematuria when they invade the urinary tract.

(4) Trauma refers to violent injuries to the urinary system.

(5) Congenital malformation polycystic kidney disease, congenital glomerular basement membrane ultrathin, nephritis, nutcracker phenomenon (the disease is caused by congenital malformation of the left renal vein that runs between the abdominal aorta and the superior mesenteric artery. Causes refractory microscopic hematuria. The right renal vein is injected directly into the inferior vena cava, and the left renal vein must be injected into the inferior vena cava through the angle formed by the abdominal aorta and the superior mesenteric artery. Normally, this angle is 45 ° to 60 ° If the congenital angle is too small or it is caused by mesenteric fat, enlarged lymph nodes, and peritoneal filling, the nutcracker phenomenon can be caused. The diagnosis is mainly based on CT, B ultrasound, and renal venography. The treatment requires surgical correction.

2. Systemic disease

(1) Bleeding diseases: thrombocytopenic purpura, allergic purpura, hemophilia, leukemia, malignant histiocytosis, aplastic anemia, etc.

(2) Connective tissue diseases: systemic lupus erythematosus, dermatomyositis, nodular polyarteritis, scleroderma, etc.

(3) Infectious diseases: Leptospirosis, epidemic hemorrhagic fever, filariasis, infective bacterial endocarditis, scarlet fever, etc.

(4) Cardiovascular diseases: congestive heart failure, renal embolism, and renal vein thrombosis.

(5) Endocrine and metabolic diseases: gouty kidney, diabetic nephropathy, hyperparathyroidism.

(6) Physical and chemical factors, such as food allergies, radiation exposure, drugs (such as sulfonamide, phenol, mercury, lead, arsenic poisoning, large infusions of mannitol, glycerol, etc.), poisons, and after exercise.

3. Diseases of nearby organs

Tumors of the uterus, vagina or rectum invade the urinary tract.

Clinical manifestations of hematuria

Change of urine color

The main manifestation of hematuria is the change in urine color. In addition to the normal hematuria color under the microscope, gross hematuria is different in color depending on the amount of bleeding. The urine was light red like meat washing water, suggesting that the blood content per liter of urine was more than 1 mL. Urine can be bloody when bleeding is severe. When the kidney is bleeding, urine and blood are mixed evenly, and the urine is dark red; bladder or prostate bleeding is bright red, and sometimes has blood clots.

2. Segmental urine abnormalities

Observe the color of the entire urine in stages, such as a three-cup urine test, and use three clean glasses to leave the initial, middle, and end-stage urine observations. For example, hematuria at the initial stage indicates that the lesion is in the urethra; hematuria at the end indicates hemorrhage The site is in the prostate and seminal vesicles of the bladder neck, triangle, or posterior urethra; all three sections of urine are red, which means full hematuria, suggesting that the hematuria is from the kidney or ureter.

3. Renal or postrenal hematuria

Microscopic hematuria color is normal, but microscopic examination can determine hematuria, and can be judged as renal or postrenal hematuria. Microscopically, red blood cells of various sizes and shapes are glomerular hematuria, seen in glomerulonephritis.

4. Symptomatic hematuria

Hematuria is accompanied by systemic or local symptoms. The main symptoms are urinary system. If accompanied by dull or colic in the kidney area, the disease is in the kidney. Bladder and urethral lesions often have frequent urgency and dysuria.

5. Asymptomatic hematuria

Some patients have neither urinary tract nor systemic symptoms in hematuria, and are seen in the early stages of certain diseases such as renal tuberculosis, kidney cancer or bladder cancer.

6. Accompanying symptoms

Hematuria with renal colic is a characteristic of kidney or ureteral stones; Hematuria with interrupted urinary flow is found in bladder and urethral stones; Hematuria with fine urinary flow and difficulty in urination are seen in prostatitis and prostate cancer; hematuria with frequent urination and urgency Found in cystitis and urethritis, accompanied by low back pain, high fever and chills are often pyelonephritis; hematuria with edema, hypertension, and proteinuria are seen in glomerulonephritis; hematuria with renal mass, can be seen in tumors, kidneys Hydronephrosis and renal cysts; bilateral swelling is seen in congenital polycystic kidneys, and mobile kidneys are seen in drooping or floating kidneys; hematuria is accompanied by bleeding from the skin and mucous membranes and other parts, and is found in blood diseases and certain infectious diseases; Hematuria with chyluria is seen in filariasis and chronic pyelonephritis.

Hematuria test

1. Ask a medical history

The color of urine, if it is red, you should further understand whether to take medicines or foods that cause red urine, whether it is a woman's menstrual period, in order to exclude false hematuria; which part of the urinary tract occurs in urinary tract, whether the whole hematuria, whether there is Blood clots; Whether it is accompanied by systemic or urinary symptoms; Whether there is recent trauma to the waist and abdomen and a history of urinary tract device examination; Whether there is a history of hypertension and nephritis in the past; Whether there is a history of deafness and nephritis in the family.

2. Location analysis of hematuria

The following three types of hematuria can be distinguished by a three-cup urine test.

(1) Hematuria at first sight Hematuria is only seen at the beginning of urination, and most of the lesions are in the urethra.

(2) Terminal hematuria Hematuria occurs at the end of urination, and the lesions are mostly in the bladder triangle, bladder neck or posterior urethra.

(3) Whole hematuria Hematuria occurs in the whole process of urination, and the bleeding site is mostly in the bladder, ureter or kidney.

3. Routine inspection methods

(1) In the urine sediment, the cast iron, especially the red blood cell cast, indicates that the bleeding comes from the renal parenchyma, which is mainly seen in glomerulonephritis.

(2) Determination of urinary protein Hematuria with severe proteinuria is almost always a symbol of glomerular hematuria.

(3) Granular cast (IGM) containing immunoglobulin in urine.

(4) Morphology of urinary red blood cells: Urine sedimentation with phase microscopy is currently the most commonly used method to identify glomerular or non-glomerular hematuria. When the number of urinary red blood cells is> 8 × 10 ⁶ / L, and the abnormal red blood cells (ring, target, bud shape, etc.)> 30%, it should be considered as glomerular hematuria. The urinary protein in urine is> 500 mg / 24 hours, which usually indicates glomerular hematuria. Such as renal pelvis, ureter, bladder or urethral bleeding (ie non-glomerular hemorrhage), the formation of red blood cells, most of the size is normal, only a small part of deformed red blood cells. If hematuria is caused by glomerular disorders, most of them are malformed red blood cells, accounting for more than 75%. They have different shapes and significant differences in size.

Hematuria diagnosis

The cause of hematuria can be analyzed from whether it is accompanied by other symptoms. Asymptomatic hematuria should first consider the possibility of urinary tract tumors; hematuria with pain, especially with colic should consider urinary tract stones; if accompanied by dysuria and interruption of urine flow, bladder stones should be considered; if accompanied by obvious Bladder irritation symptoms are more common in urinary tract infections, urinary tuberculosis and bladder tumors. In addition, the cause of hematuria should be comprehensively judged based on the patient's medical history, age, color and degree of hematuria.

Differential diagnosis of hematuria

Red urine is not necessarily hematuria and needs to be carefully discerned. If the urine is dark red or soy-colored, no turbidity and no sedimentation, microscopic examination without or only a few red blood cells, seen in hemoglobinuria; brown red or wine color, no turbidity, microscopic examination without red blood cells found in porphyrin urine; taking certain drugs such Rhubarb, rifampicin, or some red vegetables can also excrete red urine, but there is no red blood cells on microscopy.

Hematuria treatment

Patients with hematuria must stay in bed to minimize strenuous activity. Drink plenty of water to speed up excretion of medications and stones. Nephritis who have edema should drink less water. Application of hemostatic drugs, vitamin C can also be combined. Use drugs that cause hematuria with caution, especially in patients with kidney disease. Hematuria is caused by urinary tract infections, and antibiotics and urinary tract cleaners can be taken orally and injected. The cause of hematuria is complex and some are very serious. You should go to a specialist hospital for diagnosis and early treatment as soon as possible.

1. Actively treat diseases such as inflammation and stones in the urinary system.

2. In normal life, the bladder cannot be filled up frequently. Feeling urinary, that is, urination, to reduce urine retention in the bladder for too long.

3. Pay attention to the combination of work and rest and avoid strenuous exercise.

In short, hematuria is found, and early examination, diagnosis and timely treatment are needed; if it is difficult to confirm the diagnosis, regular review is needed.