Clinical urinalysis is one of the mandatory screening diagnostic methods. The routine procedure allows you to determine the acidity of urine, its specific gravity, color, concentration of s alts, glucose, as well as the presence or absence of proteins, red blood cells and other cellular elements. Due to physiological circumstances, the content of blood in the urine may exceed the permissible norm. Hematuria itself is not a diagnosis, an alarming symptom only indicates possible pathologies of the genitourinary, cardiovascular, immune and other organ systems.
Classification of hematuria
Depending on the location of the source of bleeding, there are initial, terminal and total hematuria. In the first case, erythrocytes in the test sample appear at the beginning of urination, i.e. the patient is dealing with a tumor or mechanical injury of the urethra. If blood is present only in the last portion of urine, urolithiasis, acute or hemorrhagic cystitis on the face. Total hematuria occurs with damage to the upperurinary tract (parenchyma of the kidneys, its calyces and pelvis, ureter).
Hematuria of glomerular origin leads to a change in the morphology of erythrocytes: their shape, structure, size are disturbed. If, due to blood leakage, the red bodies have to overcome an obstacle in the form of a basement membrane of the glomerular capillaries, then acanthocytes are detected. With postglomerular erythrocyturia, the blood in the urine test appears unchanged, since the damaged vessels are located after the glomerular filter.
Physiological norm
In fairness, we note that in the urine of a he althy adult or child, sometimes there is a small amount of red blood cells. Normally, their content should not exceed 1-5 cells in the field of view of the microscope. Microhematuria during pregnancy is caused by natural changes in the body of the expectant mother and rarely warns of serious pathologies. Macrohematuria, on the other hand, is not at all harmless in origin. Abundant excretion of blood cells into urine poses a threat to human life and requires emergency diagnostic and therapeutic measures.
Clinical picture
Hematuria is usually considered within the limits of the disease of which it is a sign. Often the presence of bloody impurities in urine is accompanied by subfebrile condition, frequent urination, false urge to empty the intestines. Due to blockage of the urethra with blood clots, the urine stream weakens and thins, there are pains and burning in the urethra. Pain in the lumbar regionis permanent or intermittent. Severe hematuria is manifested by signs of anemia of the body: weakness, pallor of the skin, noise or ringing in the ears, dizziness.
Diagnostic measures
Diagnosis and treatment of blood in the urine is the responsibility of a urologist. With microhematuria, urine is not visually colored red / pink, often it is detected by chance during a routine examination. While the red blood cell count is high, the presence of blood clots in the urine is noticeable to the naked eye. As a rule, after a survey, a physical examination of the patient and an assessment of the results of the OAM, it becomes clear in which area of the urinary system the source of the problem lies.
Unclear mechanism for the formation of traces of blood in the urine is specified using:
- Complete blood count.
- Bacteriological culture of urine.
- Ultrasound of the kidneys.
- Overview radiography of the kidneys.
- Excretory (intravenous) urography.
- Phase contrast microscopy.
- Investigations of vascular-platelet and coagulation hemostasis.
Hematuria should be distinguished from urethrorrhagia. With urethrorrhagia, blood from the urethra is released spontaneously, outside the act of urine excretion. It is important for women during menstruation not to confuse false hematuria with endometriosis of the bladder.
Possible causes of hematuria
Erythrocytes enter the urine from the internal or external urogenital organs located along the path of its movement. ByAccording to statistics, every second man after 45 years of age is faced with signs of prostatitis, but the disease rarely provokes the release of blood cells into the urine on its own. Usually inflammation of the prostate gland or benign prostate adenoma is combined with acute cystitis.
Women are more likely to be diagnosed with hematuria than men. This fact is explained by the anatomical structure of the female pelvic organs. In particular, the wide, relatively short urethra and its close proximity to the vagina create favorable conditions for infection of the urinary system. With postcoital cystitis, also called "honeymoon syndrome", blood in the urine and pain in the lower abdomen appear after intimacy. During intercourse, pathogenic microflora penetrates the urethra, and over time, bacteria infect the bladder mucosa.
Hematuria can be associated with traumatic injury to the urethra, ureter or kidney structures, bleeding disorders, and also:
- Urolithiasis (UCD).
- Glomerulonephritis.
- Inflammation of the bladder, urethritis.
- Gynecological ailments.
- Infectious lesions of the urinary organs (tuberculosis of the kidney or urea, schistosomiasis, some STDs).
- The presence of oncopathology.
- Vascular and autoimmune diseases.
The presence of worm-like blood clots in the urine strongly indicates kidney cancer. Due to the rough surfacemalignant or benign neoplasms easily injure the organ that “sheltered” them. If blood is found in the urine of a child, he should be examined for the presence of congenital malformations of MPS.
False positives
Rapid test strips give a false positive result in the presence of hemoglobin in the urine, so urologists strongly recommend double-checking the data in the laboratory. Intense physical activity contributes to an increase in blood pressure, increases renal circulation, thereby provoking the release of a small amount of blood into the urine. Women should not be allowed to have their urine sample contaminated with menstrual fluid.
When treated with Furadonin, Aminophenazone, Ibuprofen, the anti-tuberculosis drug Rifampicin, urine becomes red or intense orange, and patients mistakenly associate the phenomenon with hematuria. Blood in the urine in women is determined after long-term use of contraceptives.
Traditional Medicine Methods
Etiotropic therapy of hematuria is aimed at eliminating the root cause of urine discoloration. So, pathologies of an autoimmune nature are treated with immunosuppressants and corticosteroids. With urinary tract infections, antibiotics are indispensable. If the size of the stone in the kidney, urethra or ureter allows you to rely on non-surgical removal, combined agents are used that dissolve and prevent the formation of new stones. The process is facilitated by antispasmodics or thermal procedures (hot water bottle, warm bath).
In case of heavy bleeding, antihemorrhagic and iron-containing drugs are prescribed:
- "Vikasol".
- "Dicinone".
- Aminocaproic acid.
- "Ferroplex".
- "Sorbifer Durules".
If necessary, a cool solution of aminocaproic acid is poured into the cavity of the bladder by catheterization. In severe cases, the patient may need a blood transfusion, so it is advisable to treat gross hematuria in a hospital.
Surgery
Urolithiasis tends to be asymptomatic until kidney stones increase in size and blockage of the urinary tract occurs. Urological pathology is accompanied by hematuria and acute pain in the lower back (renal colic). If urolithiasis could not be cured with medications, they resort to ultrasonic crushing of stones or surgical care. Transurethral resection is performed when blood appears in the urine due to advanced prostatic hyperplasia. Small neoplasms in the kidneys are removed within he althy tissue while preserving the internal organ.
Features of food
The uncharacteristic color of urine does not always warn of a serious illness. If the diet is dominated by vegetables, fruits or berries with coloring pigments (beets, blackberries, rhubarb, red peppers, etc.)etc.), the urine will temporarily take on a reddish tint. At the same time, there should be no other deviations from the norm, such as a cloudy sediment, foam or a pungent odor. With the development of the food industry, natural or synthetic pigments began to be massively added to products, which give urine a juicy, non-specific color.
A monotonous diet favors the development of hematuria. The diet for urolithiasis is based on an enhanced drinking regimen. 1.5-2 liters of water per day accelerates the outflow of urine, thereby stimulating the excretion of s alt from the body and preventing the formation of crystals in urine. If kidney function is not impaired, include beef liver, veal, chicken and quail eggs, dried mushrooms, seaweed, cocoa in the daily menu. Iron is best absorbed from animal products.
General recommendations
Blood in the urine in men is often caused by exhausting workouts, strength or traumatic sports. In this case, proper rest will not only restore vitality, but also return the color of urine to the yellow spectrum. You can avoid postcoital cystitis by barrier contraception, use condoms without spermicides. Dress appropriately for the weather and practice basic personal hygiene. There are known cases of hematuria on the background of an unhe althy lifestyle. Give up bad habits - alcohol abuse and smoking suppress the body's immune potential.
Therapeutic tactics for hematuria directlydepends on the nature of the underlying disease. The lack of proper treatment does not have the best effect on the secretory-excretory function of the kidneys, the general well-being of the patient, and also contributes to the development of iron deficiency anemia. The organoleptic method for diagnosing blood in the urine has its drawbacks, so you should not delay visiting a medical institution. Stay he althy!
