Clinical analysis of urine is a mandatory screening diagnostic method. The routine procedure allows you to determine the acidity of urine, its specific gravity, color, concentration of salts, glucose, as well as the presence or absence of proteins, red blood cells, and other cellular elements. Due to physiological circumstances, the blood content 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.
Hematuria classification
Depending on the location of the source of bleeding, distinguish between initial, terminal and total hematuria. In the first case, the red blood cells in the test sample appear at the beginning of urination, that is, the patient is dealing with a tumor or mechanical injury to the urethra. If blood is present only in the last portion of urine, urolithiasis, acute or hemorrhagic cystitis are on the face. Total hematuria occurs in lesions of the upper urinary tract (parenchyma of the kidneys, its calyces and pelvis, ureter).
Hematuria of glomerular genesis leads to a change in the morphology of red blood cells: their shape, structure, and size are disturbed. If, due to blood leakage, the red bodies have to overcome an obstacle in the form of the basement membrane of the glomerular capillaries, then acanthocytes are detected. With postglomerular erythrocyturia, blood in the urinalysis appears unchanged, since damaged vessels are located after the glomerular filter.
Physiological norm
In fairness, we note that in the urine of a healthy adult or child, a small amount of red blood cells is sometimes present. 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 contrary, is not at all harmless in origin. The abundant secretion of blood cells in the urine poses a threat to human life and requires urgent diagnostic and therapeutic measures.
Clinical picture
Hematuria is usually considered within the disease, a sign of which it is. Often the presence of bloody impurities in urine is accompanied by low-grade fever, frequent urination, and false urge to empty the intestines. Due to clogging of the urethra with blood clots, the stream of urine weakens and becomes thinner, there are cramps and burning in the urethra. Pain in the lumbar region is permanent or cramping. 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, the urine is not visually colored red / pink, it is often detected accidentally during a routine examination. While the high content of red blood cells, the presence of blood clots in urine is noticeable to the naked eye. As a rule, after a survey, physical examination of the patient and evaluation of the results of OAM, it becomes clear in which area of the urinary system the source of the problem lies.
The unclear mechanism of the formation of blood traces in the urine is specified using:
- General blood test.
- Bacteriological culture of urine.
- Ultrasound of the kidneys.
- Radiography of the kidneys.
- Excretory (intravenous) urography.
- Phase contrast microscopy.
- Studies 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
Red blood cells enter the urine from the internal or external genitourinary organs located along the path of its movement. According to statistics, every second man after 45 years old faces signs of prostatitis, but the disease rarely provokes the release of blood cells in the urine on its own. Usually, inflammation of the prostate gland or benign prostate adenoma is combined with acute cystitis.
Representatives of the weaker sex are more often diagnosed with hematuria than in men. This fact is explained by the anatomical structure of the pelvic organs of a woman. In particular, the wide, relatively short urethra and its direct proximity to the vagina create favorable conditions for infection of the urinary system. In postcoital cystitis, also called "honeymoon syndrome," blood in the urine and pain in the lower abdomen appear after intimacy. With intercourse, pathogenic microflora penetrates the urethra, over time, bacteria damage the mucous membrane of the bladder.
Hematuria can be associated with traumatic damage to the urethra, ureter or renal structures, a violation of blood coagulation, as well as:
- Urolithiasis (ICD).
- Glomerulonephritis.
- Bladder inflammation, urethritis.
- Gynecological ailments.
- Infectious lesions of the genitourinary organs (tuberculosis of the kidney or urea, schistosomiasis, some STDs).
- The presence of oncopathology.
- Vascular and autoimmune diseases.
The presence of vermiform blood clots in the urine with a high degree of probability indicates kidney cancer. Because of the rough surface, malignant or benign neoplasms easily injure their "sheltered" organ. If blood is detected in the urine of a child, it should be examined for the presence of congenital malformations of MPS.
False positive results
Express test strips give a false positive result in the presence of hemoglobin in the urine, so urologists strongly recommend that you double-check the data in the laboratory. Intense physical activity contributes to an increase in blood pressure, enhances renal circulation, thereby provoking the release of a small amount of blood into urine. Women should not be allowed to contaminate the urine sample with menstrual flow.
When treated with Furadonin, Aminophenazone, Ibuprofen, the anti-TB drug Rifampicin, urine acquires a red or intense orange hue, and patients mistakenly associate the phenomenon with hematuria. Blood in the urine of women is determined after prolonged use of contraceptives.
Traditional Medicine Methods
Etiotropic therapy of hematuria is aimed at eliminating the root cause of a discoloration of urine. So, autoimmune pathologies 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 count on non-surgical excretion, use combined means that dissolve and prevent the formation of new calculi. The process is facilitated by antispasmodics or thermal procedures (heating pad, warm bath).
In case of heavy bleeding, antihemorrhagic and iron-containing drugs are prescribed:
- "Vikasol".
- Dicinon.
- Aminocaproic acid.
- "Ferroplex".
- Sorbifer Durules.
If necessary, a cool solution of aminocaproic acid is poured into the bladder cavity by catheterization. In severe cases, the patient may need blood transfusion, so it is advisable to treat macrohematuria in a hospital setting.
Surgical intervention
Urolithiasis tends to be asymptomatic until the kidney stones increase in size and the urinary tract becomes obstructed. Urological pathology is accompanied by hematuria and acute pain in the lower back (renal colic). If urolithiasis could not be cured with medications, resort to ultrasonic crushing 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 the healthy tissue while preserving the internal organ.
Power Features
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 pepper, etc.), the urine temporarily acquires a reddish hue. At the same time, there should not be other deviations from the norm, such as a cloudy precipitate, 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 the urine a juicy, non-specific color.
A uniform 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 salt 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 better absorbed from animal products.
General recommendations
Blood in the urine of men is often caused by exhausting workouts, power or traumatic sports. In this case, a good rest will not only restore vitality, but also return the color of urine to the yellow spectrum. Postcoital cystitis can be avoided by barrier contraception, use condoms without spermicides. Dress according to the weather, observe basic rules of personal hygiene. There are known cases of hematuria on the background of an unhealthy lifestyle. Give up bad habits - alcohol abuse and smoking suppress the body's immune potential.
The therapeutic tactics for hematuria directly depends on the nature of the underlying disease. The lack of proper treatment does not affect 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 drag it out with a visit to a medical institution. Be healthy!