Hematuria symptoms in adults. Hematuria: what is it and what happens?

Hematuria is a condition in which there is blood in the urine of a person. This cannot be called a disease, since blood in the urine can be present for many reasons. Therefore, doctors believe that hematuria is a syndrome that should be a reason to turn to specialists.

Almost always, the presence of blood in the urine is a sign of the development or already progression of the pathology of the kidneys and the entire urinary system. Most often, hematuria appears in the following cases:

there is a tumor (benign or malignant) in the urinary system or kidneys;
movement along the ureter began;
Inflammatory processes develop in the kidneys – , ;
viral infection progresses;
the man was forced long time accept medications(hematuria does not occur with all medications, but with a certain number of medications);
a foreign body has entered the urethra;
an inflammatory process develops in the bladder ().

Very often, hematuria occurs against the background of blood diseases, it can signal some serious disturbances in the functioning of the immune system.

In any case, the appearance of blood in the urine always means a malfunction of the body!

Classification of hematuria

Depending on what led to the appearance of the syndrome in question, doctors will also determine its type. In general, the classification is as follows:

extrarenal - blood in the urine did not appear due to diseases of the kidneys and urinary system, or injuries;
renal - hematuria occurs precisely against the background of kidney pathologies;
postrenal – the syndrome in question occurs against the background of diseases Bladder and/or urinary tract.

According to the degree of development of hematuria, doctors distinguish the following types:

terminal - blood is present only in the last portion of urine;
initial – blood is detected only in the first portion of urine;
total - the entire portion of excreted urine is colored red/pink.

Note:if blood in the urine is detected with the naked eye, then such hematuria is called macrohematuria, but in some cases the presence of blood in the urine can only be determined using laboratory tests - in this case we will talk about microhematuria.

The syndrome in question is most often accompanied by other characteristic signs:

urination becomes more frequent;
body temperature may rise to low-grade levels;
there is an urge to have a bowel movement, but going to the toilet does not produce results;
aching, nagging pain of a mild nature occurs in the lumbar region;
There may be cramps in the lower abdomen.

Note:brown or pink coloration of urine may be temporary and not a pathology. This happens, for example, when eating beets or rhubarb - there is no need to worry about this, the color of the urine will be restored within a day.

Diagnostics

When visiting medical institution patients with hematuria undergo a full examination - it is important to quickly and accurately determine the causes of this syndrome in order to carry out effective and competent treatment. As part of the diagnosis, patients are prescribed the following procedures:

Treatment of hematuria

Since the condition in question is not an independent disease, there is no specific, single treatment. The doctor, after determining the cause of the appearance of blood in the urine, prescribes to the patient those medications that can cure the underlying disease. These can be antibacterial agents (antibiotics) and antiviral agents. In some cases it is prescribed surgery– for example, when identifying a benign or malignant neoplasm. And if the blood in the urine appeared suddenly and in large quantities, then the patient will be prescribed hemostatic drugs, urgent measures will be taken - this condition is dangerous for the patient's life.

Note:about any independent treatment or use folk remedies out of the question! If even a small amount of blood appears in the urine, it is necessary to immediately undergo an examination in a medical institution.

Hematuria is a medical concept. It refers to the presence of blood in the urine above the norm, namely red blood cells.

Hematuria is not considered a separate disease.

But at the same time, this is the most typical symptom for urology, which indicates disorders in the kidneys, urinary tract, prostate tumor, blood clotting disorders, etc.

What is hematuria

Hematuria is one of the first signs of many diseases, in which blood appears in the urine.

Depending on the strength of the manifestation, there are:

Gross hematuria- there are a lot of red blood cells in the urine (urine from pink to brown or with blood clots);
Microhematuria– there are few red blood cells in the urine, which can only be detected in the laboratory.

There are three types violations:

Initial hematuria;
Terminal hematuria;
Total hematuria.

The concept of terminal hematuria

With terminal hematuria, only the last portion of urine is stained with blood. This happens with diseases of the bladder neck and prostate.

What are the symptoms of hematuria?

Most often the disease manifests itself:

Causes of hematuria

Blood in the urine may appear when:

Diseases of the genitourinary system;
Cancerous formations;
Injuries;
Endometriosis;
Varicose veins;
Papillomas;
Hemophilia;
Physical activity;
Hemorrhagic diathesis;
Appendicitis;
Scurvy;
Thrombocytopenic purpura;
Infections of the excretory system;
Disturbances in the blood system;
Collagenoses;
Radiation therapy;
Blood from the genitals or intestines.

Hematuria in men

Blood in the urine of the stronger sex can be detected in other ways reasons:

Prostate cancer;
Inflammation in the seminal vesicles;
Congenital kidney diseases;
Blood clotting disorders;
Problems with blood vessels;
Papillary necrosis;
Prostatitis;
Oncological diseases;
Tuberculosis of the excretory system;
Purulent inflammation;

Among women

The occurrence of hematuria in women is related to:

Causes of hematuria in a child

The causes of blood in the urine in children also have their own characteristics. These include the following:

Impaired renal excretion;
Nephrotic syndrome;
Infections of the excretory tract;
Cystic reflux;
Stones in the kidneys;
Hypercalciuria;
Urinary tract injury;
Ureteral obstruction;
Vascular diseases;
swelling;
Injuries to the external genitalia;
Foreign body in the urinary canal;
Metabolic nephropathies;
Uric acid diathesis;
Vasculitis;
Thrombopathy;
Hereditary nephritis;
Glomerulonephritis;
Kidney cancer, bladder cancer;
Cysts;
Urethroprostatitis;
Disturbances in the blood system;
Use of certain medications.

In infants and small children the only signs may be fever or pain in the lower abdomen.

Obvious abdominal pain may appear in the presence of stones in the kidneys or ureters, in children with frequent infectious diseases and congenital disorders of the urinary tract or failures of metabolic processes that provoke stone formation.

Hematuria during pregnancy

Blood in the urine of pregnant women can be detected at almost any stage, causing unnecessary anxiety in the patient and the doctor.

In most cases, such hematuria is not related to serious disorders; the pregnant woman needs to be thoroughly examined.

Often, blood in the urine of pregnant women is idiopathic, that is, it appears just like that.

This manifestation in pregnant women usually disappears after childbirth. In very rare situations, after childbirth, repetitions of hematuria appear, but they are already the result of diseases of the kidneys and excretory tract.

In women in position blood in urine may appear due to:

Enlargement of the uterus and impaired kidney function due to pressure on the ureters;

Stone formation;
Kidney inflammation or failure;
Taking anticoagulants;
Hormonal changes;
Mechanical effect of the fetus on the kidneys and excretory tract;
Rupture of the veins around the calyces of the kidneys.

In any case, it is necessary to establish and eliminate the causes of the disease, because this condition is unsafe for both the mother and the fetus.

How to treat the disease?

If you suspect hematuria, consult a doctor immediately, because earlier treatment is the key to success. Treatment of the disorder consists of treating the disease that causes it.

Depending on the reason, there are some methods of therapy:

Using antibiotics – to treat a bacterial infection;
Shock wave lithotripsy – for crushing kidney stones;
Surgical treatment depending on the diagnosis;
Combination treatment – for tumors, consisting of surgery, radiation or chemotherapy.

Features of the treatment of hematuria in women

Treatment of the weaker sex has its own characteristics, which are associated with the cause of hematuria, which is often a consequence of purely female diseases.

These are used treatment methods, to eliminate the presence of blood in female urine:

For inflammation of the urinary and reproductive systems treatment is carried out drug therapy through anti-inflammatory, antibacterial drugs;
For ligature stones that provoke the appearance of blood in urine - combined treatment - removal of stones and treatment of inflammation with medications;
For gynecological disorders – drug therapy and in severe cases surgery;
For gynecological bleeding– hemostatic therapy;
For endocrine disorders – hormone therapy. In severe situations - surgical intervention, after which hormone replacement therapy is used;
As additional ways cystitis with hematuria can be treated medicinal herbs: decoctions of viburnum, cloves, nettles, special preparations.

What should be done for prevention?

The most common reason for the appearance of blood in the urine is a bacterial infection, that is, lack of hygiene.

A significant role is played by intestinal flora, which, when it enters the urethra under certain conditions, multiplies and provokes infection.

basis prevention of excretory tract infections and as a consequence blood in urine are:

Proper execution hygiene procedures: front to back;
Wearing comfortable underwear of a suitable size;
In case of incontinence, you should change underwear, pads or diapers on time;
Regular hygiene using plain water without gels or other products;
You can't get too cold. Take special care to keep your feet warm;
Avoid sexually transmitted infections.

Hematuria is not a separate disorder, but a symptom, therefore its treatment is carried out in conjunction with the treatment of the provoking disease. After neutralization of the underlying disease, hematuria disappears.

In this case, you need to take into account that blood in the urine, even without pain, cannot be left unnoticed, especially thereby triggering the causative disease.

There is no need to panic when such a manifestation occurs, because... sometimes it appears in healthy people due to physical overload.

Human health is very fragile. It requires constant attention and support. Therefore, one should not neglect the appearance of strange symptoms, including changes in the color of urine.

Enough and general analysis urine to determine the cause of its color. If red blood cells are found in the urine, you should immediately consult a doctor and undergo additional examination.

Video: Blood in urine is a harbinger of disease

Causes of hematuria underlie the understanding that hematuria is a symptom kidney and urinary tract diseases. Blood in the urine is more often detected during laboratory tests; patients rarely complain about its appearance on their own.

Blood in the urine is visible to the naked eye at a concentration of 5 ml per 1000 ml. It gives the urine a red color, characteristic of bleeding, only during the first few hours, then the urine becomes brown. Due to this this symptom cannot be reliably excluded only on the basis of patient complaints.

Urine may turn red when taking some medicines(phenindione, rifampicin) and food products (beets). With intravascular hemolysis, free hemoglobin appears in the urine, and with rhabdomyolysis, myoglobin is determined.

Henoch-Schönlein purpura

Pathological changes resemble manifestations of IgA nephropathy. Red blood cells and urinary casts are also detected in the urine. The diagnosis is usually made by suspected skin and joint manifestations. In adults, renal pathology is more pronounced.

Benign familial hematuria

The disease manifests itself with recurrent episodes of hematuria against the background of preserved renal function. Subsequently, persistent microhematuria occurs. Kidney function usually does not change. As a rule, there is a family history of the disease. Kidney biopsy, which is not necessary if there is a family history, reveals thin basement membranes without signs of inflammation.

Alport syndrome

Alport syndrome is a rarer variant of familial glomerular pathology, manifested by hematuria, glomerulonephritis and bilateral sensorineural deafness. The disease is usually inherited in an X-linked dominant manner. As a rule, the syndrome manifests itself with massive hematuria in the first years of life, followed by microhematuria and proteinuria. Kidney pathology often develops to deafness.

Schistosomiasis

In African patients, the possibility of this disease should be kept in mind, especially if hematuria occurs at the end of urination. Eggs of Schistosoma haematobium are found in centrifuged urine.

Sickle cell anemia

People of African descent also have a higher prevalence of this disease, which is considered a risk factor for papillary necrosis. The screening test is positive if, during electrophoresis, 30-50% of hemoglobin is represented by the HbS form.

Diseases of the glomeruli of the kidneys

If erythrocyte or leukocyte casts are found in the urine in combination with altered erythrocytes, the likelihood of glomerular disease is extremely high.

The presence of protein further confirms this assumption. Renal dysfunction may occur. In some cases, if the process is suspected to be localized in the glomeruli and in the absence of a clear family history, a kidney biopsy is required to make a diagnosis.

In the absence of casts and altered red blood cells, cystoscopy and excretory urography with intravenous contrast are usually performed, however, in patients of European origin under 40 years of age, the cause of hematuria most often cannot be detected.

Tumors as causes of hematuria

Patients with hematuria over 40 years of age have a much higher risk of having a tumor detected. The most common is renal cell carcinoma, or hypernephroma. The tumor usually manifests as hematuria or groin pain. During examination, it is sometimes possible to palpate the tumor. Systemic manifestations include fever, hypercalcemia, and erythrocytosis. The diagnosis is confirmed by ultrasound examination of the kidneys.

Transitional cell carcinoma can develop from the renal medulla, along the ureter or in the bladder. The beginning is characteristic clinical picture diseases with hematuria and pain, especially if the tumor obstructs the ureter. Bladder polyps often bleed. Prostate cancer can invade the ureter and cause bleeding.

In each case, the bleeding is fresh blood without casts or deformation of red blood cells and, usually, without significant proteinuria in the absence of massive bleeding. The examination plan must include ultrasound examination of the kidneys, cystoscopy, biopsy and, in some cases, intravenous urography.

Diagnosis of hematuria

The most important causes of hematuria are presented in the box (bottom). If blood is detected in the urine, it is necessary to establish its cause. Groin pain may be a symptom of a stone, infection, kidney or ureter tumor.

Increased urination and dysuria, urinary infections, difficulty urinating, urgency and weak urine stream are often caused by prostate hypertrophy or cancer. Passing visibly blood-stained urine in the absence of others urinary symptoms characteristic of kidney cancer, tumor or polyp of the bladder. Chronic use of analgesics sometimes causes papillary necrosis of the kidneys, which manifests as hematuria or colic caused by the passage of the papilla through the ureter.

Objective research rarely yields important information.

Promotion blood pressure speaks in favor of a primary renal pathology (for example, glomerulonephritis or pyelonephritis). Sometimes there are signs of a blood clotting disorder (bruising or purpura), an increase in the size of one or both kidneys, suspicious for a kidney tumor or polycystic disease. For an infectious process, pain on palpation of the bladder, prostate or kidney is typical, depending on the location of the inflammation.

Further studies depend on the patient’s age and accompanying pathological signs, as well as the results of an extensive urine test. It is advisable to build a diagnostic algorithm depending on the clinical picture. The figure shows an approach to examining a patient with hematuria.

Urine microscopy

Common tests for detecting blood in urine are based on the reaction of hemoglobin with orthotoluidine. If the result is positive, the urine is examined for the presence of red blood cells, which are absent in hemoglobinuria. Microscopy is performed on a sample of fresh urine, since when it settles, lysis of red blood cells occurs. In addition, microscopy can detect erythrocyte and leukocyte casts, indicating kidney pathology.

An experienced microscopy specialist can provide accurate information about the location of the source of bleeding. When red blood cells pass through a glomerulus, they take on a bizarre shape, while when bleeding from a tumor or inflammation, the red blood cells are not changed.

With a positive urine test for hemoglobin, protein in the urine is not always detected, since during bleeding there may not be enough blood to obtain positive reaction. For positive result approximately 10 times more blood is needed than for the reaction to hemoglobin (about 40-50 ml of blood per 1000 ml of urine). If protein is found in slightly blood-stained urine, this indicates a lesion at the glomerular level.

Hematuria with associated symptoms

Pain and hematuria

Renal pain syndrome is characterized by dull pain in the lower back. It may be associated with hemorrhage into a tumor, stones or a blood clot in the renal pelvis, bleeding into a cyst in polycystic disease, and acute pyelonephritis.

For ureteral pain, colic is typical in combination with severe anxiety, nausea and sweating. It is usually caused by a stone in the ureter and may be associated with bleeding. Blood clot itself can provoke colic, for example with a kidney tumor or papillary necrosis.

A special diagnostic problem is presented by patients with recurrent attacks of renal pain in the lower back, combined with hematuria, the cause of which cannot be clinically identified. These are usually young women, sometimes with a history of urolithiasis; The examination does not allow a definite diagnosis to be made. In some cases, there is a history of abuse of strong analgesics. Simulation of hematuria is possible, especially in patients with medical education.

The clinical picture tends to disappear with the use of painkillers, but recurs after many years.

Increased urination and hematuria. Inflammatory diseases of the lower urinary tract cause increased urination and can lead to hematuria with severe inflammation in the mucous membrane.

Acute infection often complicates an underlying bladder disease, such as a tumor, chronic tuberculosis infection, or schistosomiasis. Typically, the diagnosis is made based on the results of urine culture, but if there is severe bleeding or if a similar clinical picture develops in a man, cystoscopy is indicated.

Asymptomatic hematuria

In young people with asymptomatic hematuria, it is often not possible to identify the cause of relapses of isolated hematuria. The presence of erythrocyte casts and erythrocytes with altered morphology is characteristic of glomerular damage. The three most common types of glomerular lesions are:

IgA nephropathy,
Henoch-Schönlein purpura,
benign familial hematuria.
IgA nephropathy.

This disease is usually detected in men aged 20-30 years; Patients have a history of episodes of pharyngitis and myalgia, after which obvious hematuria occurs over the next 24 hours, lasting 2-6 days. The disease is characterized by relapses, sometimes patients are diagnosed arterial hypertension and renal dysfunction. Changed red blood cells, red blood cell and leukocyte casts are found in the urine. The attacks go away on their own, but there is a tendency to recur.

Kidney function may slowly decline over time, although a small proportion of patients develop kidney failure very quickly. The cause of the disease is unknown, but the damage is thought to be due to the deposition of IgA immune complexes. Dense deposits of IgA are found in the mesangial space. Segmental damage to the glomeruli occurs, and proliferative changes are often detected, including the formation of crescents.

Hematuria is a term used by clinicians to refer to the presence of blood in urine in quantities that are significantly higher than normal. Hematuria is not an independent disease; it is a symptom that indicates the progression of pathologies of the kidneys and urinary tract. In this case, the excreted urine turns red-brown.

If the number of red cells is slightly increased, then microhematuria is observed. But if blood clots appear in the urine and it looks like “meat slop,” then in this case a more severe form of pathology has developed—gross hematuria.

Hematuria usually occurs unexpectedly without worsening general state patient and not accompanied by pain. The painless type of hematuria is more often diagnosed with bladder tumors. If the appearance of blood in urine is accompanied by pain and a strong burning sensation, then this indicates the progression of the inflammatory process in the organs of the urinary system (, etc.). Treatment this state performed by a nephrologist or urologist.

Etiology

Usually hematuria progresses against the background serious illnesses that require proper treatment. Under no circumstances should this symptom be ignored. The causes of hematuria are as follows:

damage to the bladder by tubercle bacilli;
kidney hemangioma;
urethral polyps;
inflammation of the seminal vesicles in men;
polycystic kidney disease;
benign;
blood diseases;
chemical cystitis;
bladder and urinary tract injuries;
cancer of the ureter, urinary tract or prostate;
chronic;
kidney malformations.

Kinds

Clinicians use a classification of hematuria that is based on the intensity of red blood cells, clinical manifestations, as well as on its origin.

By intensity:

microhematuria. The presence of blood cells can only be detected using special devices;
macrohematuria. Blood in urine can be detected with the naked eye. The color of the urine changes to dark brown or black.

Macrohematuria also has several subtypes:

initial. Red blood cells are detected in the first portion of urine excreted by the patient. The causes of this type of hematuria are injuries to the bladder and urinary canal, tumors of the urethra. Also, the initial form may appear due to damage to the urethra with various instruments during instrumental examinations;
terminal. Blood cells from the blood end up in the last portion of urine. The source of bleeding is localized directly in the bladder. This type of hematuria is provoked by bladder ulcers, stones, tumors;
total. Characteristic– all urine excreted by the patient is stained with blood. In this case, the cause of hematuria is localized in the kidneys. This symptom usually accompanies pyelonephritis, necropapillitis and other inflammatory pathologies of the upper urinary tract. If this particular form is diagnosed, it is necessary to carry out full treatment as soon as possible, as irreversible complications may begin to develop.

Origin:

glomerular;
non-glomerular.

According to clinical manifestations:

occurring with or without severe pain;
isolated;
combined with proteinuria;
persistent;
recurrent;
essential hematuria.

Symptoms

Since hematuria is not an independent disease, it is usually accompanied by symptoms of the ailments against which it developed (inflammation of the bladder, urolithiasis disease And so on). Symptoms usually appear almost immediately. The patient may complain about:

severe pain in the lumbar region ( characteristic symptom pathologies of the urinary system). The pain may radiate under the shoulder blade;
urinary disturbance;
blood in urine;
weakness;
frequent urge to urinate;
thirsty;
in case of severe pathologies of the kidneys and bladder, blood clots appear in the urine (this symptom is characteristic of hematuric nephritis);
pale skin;
dizziness;
pain in the lower abdomen;
the person cannot completely empty the bladder.

Diagnostics

If any of the above symptoms appear, it is recommended to immediately consult a doctor for a thorough diagnosis. To determine microhematuria or macrohematuria, the following examination methods are prescribed:

urine according to Nechiporenko. The analysis will make it possible to determine the number of red blood cells in the urine (the method is often used to diagnose microhematuria, when urine staining is not observed). Protein levels are also assessed;
cytological examination of urine;
urine culture;
radiography of the ureters;
intravenous pyelography;

Treatment

Treatment of macro- and microhematuria is carried out only in inpatient conditions. A treatment plan will be prescribed as soon as the doctor determines true reason the appearance of hematuria in the patient. The prognosis depends on how timely therapy was started.

If blood in the urine appears due to damage to the bladder, kidneys or urinary tract by infectious agents, then the course of treatment includes: antibacterial drugs. Typically, broad-spectrum antibiotics are prescribed first, and after testing cytological examination and urine culture, the drug may be changed.

If hematuria was provoked inflammatory process, then anti-inflammatory drugs are included in the treatment plan. If tumors are present, doctors may resort to surgical treatment pathology. The operation is also indicated for severe damage to the urinary system.

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Diseases with similar symptoms:

Urolithiasis (urolithiasis) is a pathological process that leads to the formation of stones in the bladder, ureter or kidneys. The disease is diagnosed in 3% of the total population. In young people, stones are most often found in the kidneys and ureter. In older people, pathology forms in the bladder area. Restrictions regarding age and gender, this disease does not have.

Hematuria is a symptom that is expressed by the presence of red blood cells in the urine. The excretory system reacts to any pathological condition in the body, since toxins of biological and chemical origin are usually excreted by the kidneys. Pathological processes directly in the kidneys can increase the permeability of the glomerular membrane, which leads to the leakage of blood cells. If blood appears in the urine, you should immediately seek medical attention. medical care, as the condition can be life-threatening.

Types of hematuria

By reason of occurrence, extrarenal hematuria is distinguished - not associated with kidney disease or injury, renal - directly associated with renal pathology, postrenal - as a result of damage to the urinary tract and bladder.

The presence of blood in the urine can be quite large, and then it turns red or one of its shades. In this case, they talk about macrohematuria.

If the urine retains its natural color, but a small amount of red blood cells is still present, microhematuria occurs.

Depending on which portion of urine contains blood, initial hematuria (in the first portion), total (in three portions), and final hematuria (blood in the last portion of urine) are divided. This division helps determine what level of the urinary system is affected: the higher the damage, the later red blood cells will appear.

Symptoms of hematuria

Hematuria may be accompanied by pain in the bladder and urethra during urination, immediately before it, or constant, unremitting pain. The nature of the pain is informative for the differential diagnosis.

Pain in the lumbar region, under the shoulder blade, or in the side may indicate inflammation of the kidney, injury, nephroptosis (prolapse of the kidney).

Weakness, pallor, dizziness, thirst are common signs of blood loss, usually present with total intense hematuria.

The release of sand and stones is a sign of urolithiasis.

The discharge of cylinders (oblong clots) of light yellow or brown color is an inflammatory or traumatic lesion of the kidney parenchyma.

Yellow, greenish color of the skin and sclera indicates insufficient function of the liver, gall bladder, hemolysis (destruction) of red blood cells.

Inability to empty the bladder. The condition can occur with acute massive or prolonged chronic bleeding in the urinary system with the rapid formation of a large blood clot blocking the entrance to the urethra. A large stone can also block the passage of urine.

Causes

bacterial bladder infection
pyelonephritis (inflammation of the renal pelvis)
stones in the renal pelvis or bladder
glomerulonephritis (inflammation of the kidney glomeruli and tubules)
polycystic kidney disease
kidney, bladder, prostate cancer
kidney hemangioma
aneurysm, arteriovenous fistula
inflammation of the seminal vesicles
damage to kidney tissue by autoimmune complexes
kidney or urinary tract injury
tuberculosis of the kidney, bladder
chronic renal failure
acute viral disease
thrombosis, embolism of arteries and veins
urethral polyps
acute intoxication
incorrect catheterization and sudden emptying of a full bladder with acute urinary retention (more than one liter)
kidney malformations

Diagnostics

To detect hematuria, laboratory research urine. The color of urine can be misleading as it is not always an indicator of the presence of blood. Pigment substances in food products can color urine light red or dirty pink.

Analysis using the Nechiporenko method. The first morning urine is collected in 100-150 ml. Before collection, you should toilet the external genitalia. The container for collecting urine must be sterile. Delivery of material to the laboratory within two hours.

Analysis of the daily amount of urine. Urine for analysis is collected starting from the second morning urination and ending with the first morning urination of the next day. The entire daily volume of urine is collected in one container, the volume is recorded, then mixed and part of it is poured into a 100-150 ml container. In the process of collecting material, it is necessary to maintain personal hygiene; a special preservative is used to better preserve urine.

Sediment microscopy determines the number of red blood cells in the field of view.

Phase contrast microscopy of urine sediment. The method allows you to find out whether the glomeruli and tubules are affected.

Analysis of erythrocytes stained with floxin in a buffer solution. Diagnosis is based on comparing the shape and color of red blood cells.

For differential diagnosis perform ultrasound of the pelvic organs and kidneys, cystoscopy with biopsy, excretory urography, retrograde renography, kidney biopsy, examination of the prostate and testicles, general and biochemical analysis blood, detection of antibodies to hepatitis viruses, urine culture on a nutrient medium (detection of bacterial infection), computed tomography and x-ray (foreign body detection).

Treatment

Since hematuria is a symptom, its treatment is always carried out in conjunction with the treatment of the underlying disease.

Bleeding is controlled by prescribing Dicinone, Aminocaproic acid, Vikasol, calcium chloride solution 10%. If blood loss exceeds 500 ml, infusion therapy is performed to replenish blood volume (the drug is selected according to indications).

If there is a stone in the urethra or ureter, antispasmodics and thermal procedures are prescribed to facilitate its passage. If spontaneous passage of the stone is not possible, cystoscopic or surgical removal is performed.

Kidney injuries with tissue rupture and hematoma formation are subject to emergency surgical treatment.

If hematuria is combined with high proteinuria, it is advisable to prescribe corticosteroids.

For chronic hematuria, iron supplements and B vitamins are prescribed.

Hematuria in children

In children, the appearance of blood in the urine is most often associated with damage to the kidney parenchyma. IN early age, more often shortly after birth, congenital defects already appear: spongy kidney, the presence of cysts, etc. Preventive examinations of the child necessarily include a urine test. Tuberculosis infection can proceed aggressively in early childhood which leads to defeat internal organs and can cause chronic renal bleeding. Hereditary diseases of the blood coagulation system lead to the appearance of multiple hemorrhages, and in this case hematuria is combined with hematomas and telangiectasias. The child may be injured in a fall. If there is hematuria in blood relatives without any damage to health, the baby is likely to be diagnosed with benign familial hematuria, which is associated with the structural features of the kidney.

Parents should be alert to the child's anxiety, which may be a manifestation of pain, urinary disturbance (retention), increased body temperature, and forced positioning of the body during sleep. Even if the urine color is normal, these symptoms may indicate kidney damage. Streptococcal infection at an early age can affect the renal parenchyma and cause hematuria. IgA nephropathy may occur after viral disease upper respiratory tract. More often the disease has benign character and does not lead to chronic renal failure. A malignant course is indicated by increased blood pressure, proteinuria, and gross hematuria.

Hematuria in pregnant women

During pregnancy, blood in the urine is most likely to appear in the second or third trimester. As the fetus grows, the uterus compresses the ureters, which can negatively affect kidney function. Stagnation of urine in the pelvis can provoke the formation of stones, which damage the epithelium and cause bleeding. If before pregnancy a woman suffered from kidney inflammation or has chronic renal failure, then the likelihood of hematuria increases dramatically. It is important to differentiate bleeding from the urinary tract from the uterine, since the second condition is extremely dangerous for the mother and fetus. During pregnancy, the activity of the blood coagulation system increases, and the woman may be prescribed medications to correct it. Taking anticoagulants can cause hematuria, and stopping the bleeding is often sufficient to stop them.