Hematuria: Types, Causes, Symptoms, Diagnosis, Treatment, Prevention and Prognosis

It refers to a condition in which there is the presence of red blood cells (erythrocytes) in the urine.

The bleeding may occur only once or it may be recurring.

Normally, urine is yellow in color due to the presence of a pigment called urobilirubin.

This pigment is the result of the breakdown of hemoglobin, the oxygen-carrying protein of red blood cells.

In some cases, a large number of red blood cells may be present, but they are only visible when viewed under a microscope (called microscopic hematuria ), while in other cases the blood is clearly visible to the naked eye due to redness or color. reddish brown urine.

The amount of blood in the urine is not a correct indication of the severity of the underlying problem.

Whatever the type or nature of the condition, hematuria could be an indication of bleeding in the urinary system that includes the kidneys, ureters (the tubes that carry urine from the kidneys to the bladder), the bladder, and the urethra. (the tube that carries urine from the bladder) and the prostate gland.

Pseudohematuria

It should be noted that there may be different reasons why urine acquires a red tint.

If the red color of the urine is caused by anything other than red blood cells, then the condition is known as “pseudohematuria.”

Urine color is due to the presence of pigments such as porphyrin, myoglobin, or betanin (after eating beets), eating berries or rhubarb, coloring food, or taking antipsychotic medications such as chlorpromazine and certain laxatives and tranquilizers can impart a red or red hue. rose.

Poisoning due to lead or mercury can cause urine to turn red due to excessive amounts of porphyrin in the urine.

An infection may be suspected if white blood cells are found along with the red blood cell count.

Hematuria often indicates different problems in men and women and occurs with a frequency of 10% in the general population.

Medications can not only make urine look red, sometimes even orange, green, or black.

Here are some of the common drugs that can alter urine color:

Drugs that turn urine orange

  • Pyridium or phenazopyridine: used for urinary infections.
  • Rifampin – Used to treat tuberculosis.
  • Vitamin B supplements.

Drugs that turn urine black

  • Methyldopa or Aldomet – Used to treat blood pressure.

Substances that turn urine blue or green

  • Methylene blue dye.

Types of hematuria

Hematuria is classified into the following types:

  • Microscopic hematuria : when red blood cells in the blood are visible only through a microscope.
  • Gross or thick hematuria: when the urine is red, reddish brown or pink due to the excessive presence of red blood cells. In these conditions, blood clots can also be present.
  • Idiopathic hematuria: when there is a high number of red blood cells in the urine with no underlying cause.
  • Hematuria of players: when hematuria is the result of the discordance of the urinary bladder. This generally occurs in a regular runner or a long distance runner.

Causes

It is important to note that hematuria has multiple causes.

In many people, blood in the urine is seen without any associated problems, while in others it is caused by factors such as physical exercise and therefore may not require treatment.

In such cases, it tends to resolve quickly.

However, hematuria can also be caused by very serious conditions and it is for this reason that the doctor should be consulted as soon as blood is observed in the urine.

Age is also a vital factor, as childhood causes may differ from adult causes.

The bleeding may occur once or it may recur.

It can indicate different problems in men and women.

The causes of this condition range from the non-life threatening, such as a urinary tract infection, to the more serious, such as cancer or kidney disease.

Therefore, a doctor should be consulted as soon as possible.

Many conditions are associated with hematuria. The most common causes include the following:

  1. Trauma – A traumatic injury to any part of the urinary tract, from the kidneys to the opening of the urethra (the connection between the bladder and the outside world), can cause hematuria.
  2. Drugs : Hematuria can be caused by medications, such as blood thinners, such as heparin, warfarin (Coumadin) or aspirin-like medications, penicillins, medications that contain sulfa and cyclophosphamide (Cytoxan), medications such as quinine, rifampin, phenytoin.

There are rare diseases and genetic disorders that also cause hematuria. Some of them are:

  • Bleeding disorders: include the family of hemophilia, sickle cell anemia (inherited blood disorder).
  • Von Hippel-Landau disease : An inherited disease in which benign tumors form in the spinal cord, kidneys, testicles, and other organs.
  • Urinary tract infection: Hematuria can be caused by an infection in any part of the urinary tract, most often the bladder (cystitis) or the kidney (pyelonephritis).
  • Kidney stones and bladder stones.
  • Tumors and / or cancer in the urinary system.
  • Glomerulonephritis: is a family of diseases characterized by inflammation of the glomeruli, the filtering units of the kidneys. Glomerulonephritis is a rare complication of certain viral and bacterial infections (including strep throat) and vasculitis.
  • Benign prostatic hyperplasia (enlarged prostate) in men over 40 years of age.
  • Prostate infection or inflammation ( prostatitis ): Viral urinary tract infections and sexually transmitted diseases, particularly in women. Urinary tract blockages

Symptoms

By itself, hematuria rarely causes symptoms. An exception is when the bladder is so bloody that clots form and the flow of urine is blocked.

This can cause pain at the site of the blockage in the lower pelvis.

Symptoms generally stem from the disease causing hematuria and vary depending on the condition:

  • Glomerulonephritis: If glomerulonephritis is not severe, it may not cause any symptoms. If symptoms appear, they can include swelling, especially in the lower extremities, decreased urination, and high blood pressure.
  • Kidney or bladder infection: Symptoms depend on the site of infection, but may include severe pain on one side of the middle back, fever, chills, nausea and vomiting, pain over the bladder or pubic region, foul-smelling urine , need to urinate more often than normal, and pain or discomfort when urinating.
  • Prostate infection: There may be pain in the lower back or in the area between the scrotum and the anus, pain during ejaculation, blood in the semen, and sometimes fever and chills.
  • Kidney or bladder tumor: Most kidney and bladder cancers grow without causing any pain or discomfort. When symptoms develop, the most common are abdominal pain, more frequent urination, and pain at the end of urination.
  • Kidney stones: When a kidney stone becomes trapped in one of the ureters (the narrow tubes that connect each kidney to the bladder), it can cause severe pain in the back, sides, or groin, nausea and vomiting, or pain when urinating with frequency.
  • Bleeding disorders : Bleeding disorders tend to cause abnormal bleeding throughout the body, not just in the urine.
  • Trauma – There will often be signs of traumatic injury to the surface of the body, such as bruising, swelling, punctures, and open wounds.

Call a doctor immediately if you notice blood in your urine or if your urine turns the color of tail.

Your doctor should also be called if you have a fever or pain in your lower abdomen or side.

Diagnosis

The doctor will take a medical history and family medical history, especially any history of kidney disease, bladder problems, or bleeding disorders.

The doctor will also ask about any recent trauma or strenuous exercise, recent viral or bacterial infections, medications you take, and your symptoms, which include more frequent urination, painful urination, and pain in your side.

The doctor will also examine the patient, take his temperature and blood pressure, and check for pain or discomfort in his side or over his bladder.

The doctor may recommend that women have a pelvic exam and men have a prostate exam.

The doctor will order a urine sample to confirm hematuria. In women, blood can enter the urine during menstruation. Your doctor may want to repeat the urine test between periods.

Urine is tested in the laboratory for protein, white blood cells, and red blood cells to identify an infection of the kidneys or bladder, or inflammation of the kidneys (glomerulonephritis).

Then, depending on the suspected cause of the hematuria, additional tests may include:

Urine culture: In this test, a urine sample is monitored to see if bacteria grow. This test is used to confirm a kidney or bladder infection.

CT scan of the kidneys, ureters, and bladder: In most cases, CT scan is done without intravenous contrast.

If additional information is still needed, the radiologist may want to inject a dye (also called contrast medium) into the vein in the arm.

The dye accumulates in the kidneys and is excreted in the urine, providing a contour of the entire urinary system. The radiologist should be informed about allergies, especially any previous reaction to the contrast medium.

Ultrasound: This test uses sound waves to help establish whether a kidney mass is a non-cancerous (benign) fluid-filled cyst or a solid mass, such as a cancerous tumor. Ultrasound can also identify kidney stones.

Cystoscopy: In this test, the doctor inserts a flexible telescope into the urethra and passes it into the bladder to inspect the lining of the bladder for tumors or other problems. This test is usually done under local anesthesia and sedation.

Blood tests: They can detect signs of urinary tract infection, kidney failure, anemia (which often accompanies kidney problems), bleeding disorders, or abnormally high levels of blood chemicals that can promote kidney stone formation.

Additional tests may be recommended for conditions that cause kidney inflammation (such as lupus), based on findings from routine blood and urine tests.

Expected duration

The duration of hematuria depends on its underlying cause.

For example, hematuria related to strenuous exercise usually goes away on its own within 24 to 48 hours.

Hematuria as a result of a urinary tract infection will end when the infection is cured.

Hematuria related to a kidney stone will clear up after the stone is passed or removed.

Prevention

To avoid hematuria related to strenuous exercise, you should switch to a less intense exercise program.

In general, you can help prevent other forms of hematuria by following a lifestyle that supports a healthy urinary tract:

  • Stay well hydrated. Drink about eight glasses of fluids daily (more during hot weather).
  • Avoid smoking cigarettes, which are linked to urinary tract cancer.
  • Eat a balanced diet and avoid excess salt and protein.
  • Urinate when you feel like it and you should avoid holding your urine for long periods of time.
  • Avoid hygiene products that irritate the genital area

Treatment

Treatment of hematuria depends on its cause.

In general, people with exercise-related hematuria need no treatment other than modifying their exercise programs.

People with drug-related hematuria will get better if they stop taking the drug that caused the problem.

Antibiotics will typically cure infection-related hematuria.

For other causes of hematuria, treatment can be more complex:

Kidney stones: Sometimes smaller stones can be removed from the urinary tract by drinking lots of fluids. Larger stones may require surgery or lithotripsy, a procedure that breaks the stone’s structure.

Trauma: Treatment depends on the type and severity of the injuries. In severe cases, surgery may be necessary.

Bladder or kidney tumor: Treatment is determined by the type of cancer and the extent of the cancer (its stage), as well as the patient’s age, general health, and personal preferences.

The main types of treatment are surgery, chemotherapy, radiation therapy, and immunotherapy, a type of treatment that stimulates the immune system to fight cancer.

Glomerulonephritis: Treatment may include antibiotics to treat any infection, medications called diuretics that help increase the amount of urine excreted from the body, medications to control high blood pressure, and dietary changes to reduce the work of the kidneys.

However, children who develop glomerulonephritis after a strep infection often recover without any treatment.

If it is caused by an autoimmune disorder, such as lupus, medications to suppress the immune system, including corticosteroids or cyclophosphamide (Cytoxan, Neosar), may be prescribed.

Bleeding disorders: Treatment depends on the specific type of bleeding disorder. Hemophilia patients can be treated with clotting factor infusions or fresh frozen plasma, a type of transfusion that provides the missing factors.

Forecast

Most people whose hematuria is related to exercise, medication, kidney stones, urinary tract infections, or prostatitis have an excellent outlook for full recovery.

Children with hematuria as a result of glomerulonephritis usually make a full recovery if their disease is mild or develops after a strep infection.

Adults with glomerulonephritis are less likely to recover on their own, although the outlook depends on the specific type of glomerulonephritis.

The more severe forms of the disease can eventually lead to chronic kidney failure. For people with kidney or bladder cancer, the outlook depends on the stage and type of tumor.

In general, if a kidney or bladder tumor is diagnosed early, the cancer can often be cured.

Although people with hemophilia can have repeated episodes of bleeding (including bleeding in the joints, internal organs, and other parts of the body), recent advances in treatment have achieved near-normal life expectancies for many patients.