Hematuria
by Julie Chacko, M.D.
• Definition:
· Hematuria is defined as blood in the urine.
· Gross hematuria refers to blood that is visible with the naked eye while microscopic hematuria refers to blood that is seen only when the urinary sediment is examined under the microscope.
• Overview:
· It is generally accepted that gross hematuria always warrants a work-up while that is not always the case with microscopic hematuria.
· Microscopic hematuria is generally considered significant when there are three or more red blood cells per high power field in the urinary sediment in at least two of three urine samples.
· There is no current recommendation for routine urine testing to screen for hematuria.
· There are many causes for hematuria as the blood can come from any source in the urinary tract including the kidneys, ureters, bladder, prostate or urethra.
· A few of the more common benign etiologies include but are not limited to the following: enlargement of the prostate (BPH), bladder infection, kidney infection, kidney stone, bladder stone, abnormal blood vessels, kidney diseases, history of radiation therapy and trauma to the urinary tract.
· Tumors, both benign and malignant, of the urinary tract are the more concerning causes of hematuria and the reasoning behind the complete work-up.
· There are situations in which there appears to be blood in the urine that is not in fact concerning such as menstrual bleeding or in patients who have difficulty collecting a true “midstream, clean-catch” sample.
· Blood thinning medications in and of themselves often make hematuria present or worse but are not considered an etiology and therefore most patients on blood thinning medications will be worked up in the same manner as those not on such medications.
• Types: Gross vs. Microscopic as described above.
• Symptoms:
· Hematuria in itself is generally asymptomatic with the exception of when it is heavy enough to clot and cause obstruction of the urinary tract with which patients may experience pain in the flank similar to passing a kidney stone (if the bleeding is from the kidney) or difficulty emptying the bladder if a clot obstructs the outflow of the bladder.
· Difficulty emptying the bladder may worsen to the point of urinary retention (inability to urinate).
· Depending upon the cause of the hematuria, for which there are many, the associated symptomatology varies from no symptoms at all to pain or other symptomatology severe enough to make a patient go to the Emergency Department.
• Complications:
· Hematuria can cause obstruction of the urinary tract as mentioned above.
· If very heavy hematuria occurs or prolonged microscopic hematuria persists, anemia can develop.
• Clinical Findings/signs:
· The signs and symptoms of hematuria vary depending on the cause.
· Blood in the urine is the sign.
• Treatment:
· Hematuria is a sign and not in itself a disease therefore it requires a work-up to determine the cause of the bleeding following which treatment of the underlying disease is the ultimate goal.
· When gross hematuria is causing urinary retention or clot colic (kidney pain) measures may be taken including irrigation of the bladder and admission to the hospital for monitoring and management of the bleeding and any associated complications from the bleeding.
· Work-Up: To find the source of the bleeding the patient generally will undergo some form of imaging of the kidneys (ultrasound, CT scan or other study) as well as testing of the urine and a cystoscopy (camera inspection of the bladder). Cystoscopy is generally performed in the doctor’s office and is well-tolerated with local analgesia. The camera is introduced down the urethra and the bladder is inspected for any stone, tumor or other etiology. It is generally a fairly quick procedure and once performed the mild burning on urination will resolve within two urinations or 24 hours.
• Prognosis:
· Hematuria is a sign and not a disease therefore prognosis depends upon the underlying etiology that is discovered when the work-up is performed.
Posted on April 16, 2009
[...] Complications: · Fever · upper urinary tract infection (see pyelonephritis) · hematuria (blood in the [...]
[...] Complications: · Fever · Upper urinary tract infection (see pyelonephritis) · Hematuria (blood in the [...]