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Hematuria

Hematuria refers to appearance of red blood cells (RBCs) in the urine, which may either be visible to the naked eye (termed as gross/macroscopic hematuria) or detected with a microscope (referred to as microscopic hematuria).

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This condition may result from abnormalities within the kidneys or within the ureters and is noted commonly in children. In some cases, underlying blood disorders may be the causative factor.

Gross hematuria may also be noted in adults wherein it may often symbolise cancerous involvement (in case of adults over 40 years of age).1 

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Signs and symptoms of hematuria

Blood in the urine, which may be grossly observed or is discovered in routine microscopic examination of urine, is the classical feature of numerous disorders of the kidney and the ureters/bladder.

Other associated signs and symptoms vary based on the underlying disorder and can include a wide range of features such as

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  • Blurring of vision
  • Altered senses
  • Seizures
  • Breathlessnes
  • History of sore throat or skin infection

Other features such as joint pain, skin rashes and prolonged fever may also be noticed.

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Some of the signs may be specific to the abdominal area and include

  • Painful urination
  • Decreased or absent urination
  • Urgency to urinate
  • Pain in the abdomen region or lower back region.2

Causes of hematuria

The causes of hematuria can be categorized as those due to renal (kidney) causes or due to urinary tract abnormalities (urological).

Certain underlying bleeding disorders may be the causative factor in certain instances while microscopic hematuria may be noted after rigorous physical exercise in the absence of any underlying disorders. 

The common renal causes that have been associated with RBCs in the urine include:

  • Active glomerular nephritis
  • Acute interstitial nephritis
  • Nephrotic syndrome
  • Progressive glomerular nephritis

The abnormalities/disorders of the urinary tract that can result in hematuria include:

Various factors have been described to be associated with an increased incidence of hematuria.

These include

  • Smoking
  • Occupational exposure to chemicals (such as benzenes or aromatic amines)
  • Age over 40 years
  • History of gross hematuria
  • Urological disease
  • Urinary tract infection
  • Pelvic irradiation
  • Abuse of painkillers

In case of children, the causative factor is usually an infectious condition such as post-streptococcal glomerulonephritis.

It should be noted that the color of the urine might be changed due to consumption of certain foods such as beets or due to red dyes in food and certain medications such as chloroquine, phenazopyridine, rifampicin or pyridium.1,2

Diagnosis of hematuria

The diagnosis of hematuria is confirmed by simple examinations. However, further analytic tests are advised to identify the probable cause of hematuria.

The doctor confirms the presence of blood in the urine based on the history of the condition and a simple test known as ‘dipstick test’.

If hematuria is confirmed then, further investigations are advised to identify the underlying cause.

These include

  • Blood tests
  • Examination of urine sample under microscope
  • Culture of urine sample
  • And in certain cases cystoscopy

Following Imaging studies also helpful in diagnosis of hematuria

Intravenous urography (IVU)/intravenous pylography (IVP) may also be advised in certain cases.

Further invasive tests such as biopsy of the kidney may at times be required.1

Treatment of hematuria

The treatment of hematuria is based on the severity of the condition and the underlying pathology that would have resulted in hematuria.

Individuals with asymptomatic microscopic hematuria that has never been observed in them usually do not require any treatment but they are required to monitor on a quarterly or yearly basis.

Other individuals with underlying disorders are appropriately treated with medications or surgical therapy.

Certain modifications in the diet such as decreasing the consumption of salt may also be advised additionally.

Complications of hematuria  

The complications of hematuria vary based on the underlying pathological conditions. Formation of kidney stones and kidney failure are some of the general complications.

Prevention of hematuria

Early and prompt identification and treatment of the disorders affecting the urinary system helps in the prevention of complications such as hematuria.

References:

1.Rodgers M, Nixon J, et al. Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation. Health Technol Assess. 2006; 10(18).

2.Indian Pediatric Nephrology Group, Indian Academy of Pediatrics. Consensus statement on evaluation of hematuria. Ind Ped. 2006; 43: 965–973.

Written by: healthplus24.com team

Date last updated: January 28, 2016