Red blood cells are blood cells that are responsible for the transport of hemoglobin to body tissues. Normally, these cells are only in the bloodstream and should not go beyond it. But there are pathological conditions in which they enter the urine. What does the presence of unchanged red blood cells in urine indicate? And how to deal with this problem? About this in detail in the article.
What does the term "hematuria" mean?
Hematuria is the presence of blood cells in the urine. But their presence is not always referred to by this term. Scientists have found that more than 2 million red blood cells enter the urine per day. But laboratory tests will characterize this figure differently. When examining urine using microscopy, the norms of red blood cells in the urine are as follows:
- women - up to three red blood cells in sight;
- men - up to two red blood cells in sight;
- newborns - two to four cells in sight.
Therefore, hematuria is considered the appearance of unchanged red blood cells in the urine in women in an amount of 4 or more in the field of view, in men - 3 or more.
According to the number of cells in the urine, hematuria is divided into two groups:
- macrohematuria - 50 or more red blood cells are found in the field of view, the color of urine is changed to red or brown, or drops of fresh blood are observed at the end of urination;
- microhematuria - the color of the urine is not changed; microscopic examination determines less than 50 red blood cells in the field of view.
Pathogenesis of hematuria
Pathogenesis is a phased description of the development of a particular disease. Knowing how altered and unchanged red blood cells appear in the urine will help in understanding the symptoms and treatment of hematuria.
Red blood cells enter urine through one of the following mechanisms:
- If the walls of the membrane of the capillaries that supply blood to the kidneys are damaged. Their structure can be destroyed due to injuries, inflammation, and tumor growth.
- With stagnation in the veins of the pelvis, which occurs with phlebitis, external compression of the veins by pathological neoplasms.
- In case of violation of the structure of the urinary system: ureters, bladder, urethra. It develops with inflammation of the mucous membrane of these organs.
The presence of unchanged red blood cells in urine suggests that the pathology is below the level of the kidneys. That is, the ureters, bladder or urethra are affected. And if in the general analysis of urine the presence of altered red blood cells is noted, it is worth suspecting the pathology of the kidneys themselves. This is due to the fact that in kidney disease, the red blood cells change their structure, passing through the membrane of the capillaries.
Causes of Hematuria
The presence of unchanged red blood cells in the urine does not necessarily indicate any pathology. They can penetrate urine for the following physiological reasons:
- excessive physical activity;
- chronic stress;
- alcohol abuse;
- prolonged exposure to the sun or bath, which led to overheating of the body.
But in the vast majority of cases, the cause of increased unchanged red blood cells in the urine is the disease:
- acute or chronic cystitis - inflammation of the bladder;
- urolithiasis disease;
- acute or chronic urethritis - inflammation of the urinary tract;
- trauma to the abdomen with damage to the organs of the urinary system;
- prostate adenoma or prostatitis in men;
- gynecological diseases in women - uterine fibroids, cancer of the body or cervix, bleeding from the organs of the reproductive system;
- blood clotting disorder - hemophilia, idiopathic thrombocytopenic purpura.
Causes of altered red blood cells in the urine
As already noted above, altered red blood cells in urine indicate a pathology of the kidneys themselves. Violation of the structure of the renal capillaries cause such diseases:
- glomerulonephritis - an autoimmune inflammation of the glomeruli of the renal capillaries;
- tuberculous damage to the kidneys;
- oncological neoplasms;
- pyelonephritis - an inflammation of the kidneys of a bacterial nature;
- autoimmune vascular disease (hemorrhagic diathesis);
- taking drugs that are toxic to the organ - sulfonamides, anticoagulants;
- prolonged increase in blood pressure.
Clinical manifestations
The fact that unchanged red blood cells in the urine are elevated does not yet give reason to make any specific diagnosis. The final cause of hematuria is determined in accordance with clinical manifestations and data from other diagnostic examination methods.
Not always elevated unchanged red blood cells in the urine are accompanied by symptoms. Asymptomatic or painless hematuria is distinguished. It most often occurs suddenly. Represents the allocation of large blood clots with urine. Pain or other unpleasant symptoms are absent. In this case, first of all, it is necessary to exclude a tumor of the bladder or kidney.
Also, hematuria can occur with violent symptoms. The allocation of blood is accompanied by severe pain in the lower abdomen or in the lumbar spine. Possible fever and poor health. Urine is excreted in small portions. In this case, the patient is likely to have urolithiasis.
Elevated unchanged red blood cells in the urine are a common sign of cystitis in women. Then hematuria is accompanied by constant urge to urinate, burning during it. The amount of urine is small, blood comes out in drops at the end of urination.
An approximate source of bleeding can be determined by the shape of a blood clot. If it has a worm-like shape, then the red blood cell passed through the ureter. That is, the source of bleeding should be sought in the kidney or directly in the ureter.
Unchanged red blood cells in the urine of a child
Hematuria in adolescence often appears due to infectious diseases of the urinary system. Often this problem affects young girls. If hematuria is accompanied by a deterioration in general condition, an increase in body temperature, it is worth suspecting pyelonephritis or cystitis.
But the appearance of unchanged red blood cells in the urine of a child in the first months of life does not always indicate pathology. The number of fetal red blood cells during fetal development is increased, and at birth they begin to decay massively. Therefore, microhematuria in a newborn is normal.
The value of a three-glass sample
If the doctor found unchanged red blood cells in the urine, the next step is to determine the level of damage. In this, a three-glassed test comes to the rescue.
Before carrying it out, the patient should refrain from urinating for 3-5 hours. The patient urinates in three containers alternately. At the same time, about 1/5 of the total volume of urine is collected in the first container, 3/5 in the second, and the remaining volume in the third. Urine immediately goes to the laboratory for research.
The results are deciphered as follows:
- The presence of blood in the first portion and its absence in the subsequent volume of urine indicates the presence of a source of bleeding in the urethra (urethra).
- Hematuria, which is found only in the final portion of urine, indicates the presence of pathology in the bladder or prostate disease in men.
- If red blood cells are found in all portions of urine, they say about kidney or ureter disease.
- Hematuria in the first and last portion, as well as the absence of red blood cells in the second glass, with high probability indicates damage to the prostate and urethra at the same time.
Additional diagnostic methods
Determining the cause of unchanged red blood cells in the urine is almost impossible without an additional examination of the patient. Most often, the doctor prescribes the following diagnostic methods:
- Ultrasound examination - helps to diagnose urolithiasis, kidney disease.
- Cystoscopy is a method for diagnosing diseases of the bladder, which consists in examining its mucous membrane using a microscopic camera.
- Urography with the introduction of contrast is an X-ray method for diagnosing diseases of the urinary system.
- Scintigraphy is a method of examining internal organs using radioactive isotopes. Used for suspected tumor formation.
- Computed tomography is an X-ray method that allows you to accurately see the structure of internal organs and their relationship to each other.
Any of the above survey methods is not prescribed routinely. Only a doctor can prescribe a referral!
Differential diagnosis
Answering the question of what this means - unchanged red blood cells in the urine, it is worth noting that their presence does not necessarily indicate a pathology of the urinary system.
In women, the appearance of blood in the urine may indicate menstruation. The color of urine will help distinguish menstrual blood from true hematuria. During menstruation, the urine remains light, and if there is a pathology of the urinary organs, it becomes cloudy or claret.
There is also a condition called urethrorrhagia. In this case, the blood flows from the urethra constantly, and not just when urinating. Urethrorrhagia can occur with severe diagnostic or therapeutic interventions (catheterization, urethral bougienage), urethral trauma.
Hemoglobinuria and myoglobinuria: what is it?
A condition similar to hematuria is called hemoglobinuria. It is manifested by the ingestion of hemoglobin in the urine. It develops with a strong destruction of red blood cells inside the vascular bed with the release of hemoglobin. The following situations may be the cause of this condition:
- Hemorrhagic shock during transfusion of incompatible blood in a group or Rh factor;
- hydrogen sulfide poisoning;
- severe infectious diseases;
- hemolytic anemia of hereditary or acquired nature;
- large burns.
The dark red color of urine can occur when myoglobin enters it. Myoglobin is a protein that forms when skeletal muscle breaks down. This situation often occurs in people who have long been under collapses. This is called prolonged compression syndrome. Myoglobin accumulates in the tubules of the kidneys and damages their function.
Treatment methods
Therapy with unchanged red blood cells in the urine largely depends on the cause of the pathology. Conventionally, all treatment can be divided into medical and surgical.
Medication is used for infectious inflammatory diseases of the kidneys, bladder and urethra. So, pyelonephritis, urethritis and urethritis are treated with antibacterial drugs.
With more serious pathologies, they resort to surgical intervention. For example, the appearance of neoplasms requires their speedy resection. Rapid tumor growth can damage organ function. In this case, its complete removal will be required.
The presence of unchanged red blood cells in the urine is a versatile symptom, which can be a manifestation of many diseases. Therefore, if during urination you find a change in the color of urine or the appearance of clots of fresh blood, do not hesitate, contact a specialist!