|
|
| Line 18: |
Line 18: |
|
| |
|
| {{SK}} Haematuria | | {{SK}} Haematuria |
| ==Overview==
| |
|
| |
|
| '''Hematuria''' is the presence of [[red blood cells]] (erythrocytes) in the [[urine]]. Occasionally the term "[[hemoglobinuria]]" is used synonymously, although more precisely it refers only to [[hemoglobin]] in the urine.
| | ==[[Hematuria overview|Overview]]== |
|
| |
|
| == Types of Hematuria== | | ==[[Hematuria classification|Classification]]== |
| Red discoloration of the urine can have various causes:
| |
| * [[Red blood cell]]s
| |
| ** [[Microscopic hematuria]] (small amounts of blood, can be seen only on [[urinalysis]] or [[light microscopy]])
| |
| ** Macroscopic hematuria (or "frank" or "gross") hematuria
| |
| * [[Hemoglobin]] (only the red pigment, not the [[red blood cell]]s)
| |
| * Other pigments
| |
| ** [[Porphyrin]]s in [[porphyria]]
| |
| ** [[Betanin]], after eating [[beet]]s
| |
|
| |
|
| ==Symptoms== | | ==[[Hematuria pathophysiology|Pathophysiology]]== |
| In assessing the underlying cause of hematuria, the patient should be asked the following questions::
| |
| * Have you passed any [[blood clot]]s?
| |
| * Has a [[kidney stone]] been passed (have you heard a noise in toilet bowl)?
| |
| * Is the red color mixed in completely, or does the color change during an episode of urination?
| |
| * Does it occur only after getting up?
| |
| * Have you recently had a sore throat?
| |
|
| |
|
| == Diagnosis == | | ==[[Hematuria causes|Causes]]== |
| Often, the diagnosis is made on the basis of the medical history and some [[blood test]]s—especially in young people in whom the risk of malignancy is negligible and the symptoms are generally self-limited.
| |
|
| |
|
| [[Ultrasound]] investigation of the renal tract is often used to distinguish between various sources of bleeding. [[X-ray]]s can be used to identify [[kidney stone]]s, although [[computed axial tomography|CT scanning]] is more precise. | | ==[[Hematuria differential diagnosis|Differentiating Hematuria from other Diseases]]== |
|
| |
|
| In older patients, [[cystoscopy]] with [[biopsy]] of suspected lesions is often employed to investigate for [[bladder cancer]].
| | ==[[Hematuria epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| * [[Urinalysis]] for all patients
| | ==[[Hematuria risk factors|Risk Factors]]== |
| * [[Complete blood count]] ([[CBC]])
| |
| * [[Calcium]]
| |
| * [[Uric acid]]
| |
| * [[Prothrombin time]] / [[Partial thromboplastin time]] ([[PT]] / [[PTT]])
| |
| * [[Blood urea nitrogen]] ([[BUN]]) / [[creatinine]]
| |
|
| |
|
| A more complete evaluation would include the following:
| | ==[[Hematuria natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * C3 levels
| |
| * Red blood cells casts
| |
| * Cyroglobulins
| |
| * Hepatitis C antibodies
| |
| * Anti-glomerular basement membranes (GBM)
| |
| * Antinuclear anitbodies (ANA)
| |
| * Antineutrophil cytoplasmic antibodies (ANCA)
| |
| * Antistreptolysin O antibodies (ASO)
| |
|
| |
|
| == Common Causes == | | ==Diagnosis== |
| Common causes of ''macroscopic hematuria/ haematuria'' (i.e. blood visible in the urine) include:
| | [[Hematuria history and symptoms| History and Symptoms]] | [[Hematuria physical examination | Physical Examination]] | [[Hematuria laboratory findings|Laboratory Findings]] | [[Hematuria x ray|X Ray]] | [[Hematuria ultrasound|Ultrasound]] | [[Hematuria other diagnostic studies|Other Diagnostic Studies]] |
| * [[Thin basement membrane disease|Benign familial hematuria]]
| |
| * Urinary [[Schistosomiasis]] (caused by ''[[Schistosoma haematobium]]'') - a major cause for hematuria in many African and Middle-Eastern countries;
| |
| * [[IgA nephropathy]] ("Berger's disease") - occurs during viral infections in predisposed patients;
| |
| * [[Kidney stone]]s (or [[bladder stone]]s, now a rare disease);
| |
| * [[Bladder cancer]];
| |
| * [[Renal cell carcinoma]] - occasionally presents with bleeding;
| |
| * [[Paroxysmal nocturnal hemoglobinuria]] - a [[rare disease]] where [[hemoglobin]] of [[hemolysis|hemolysed]] cells is passed into the urine.
| |
| * [[Urinary tract infection]] with some bacterial species including strains of [[Escherichia coli#Urinary tract infections|EPEC]] and [[Staphylococcus saprophyticus]]
| |
| * [[Sickle cell trait]] can precipitate large amounts of red blood cell discharge, but only a small number of individuals endure this problem
| |
| * [[Arteriovenous malformation]] of the kidney (rare, but may impress like renal cell carcinoma on scans as both are highly vascular)
| |
| * Nephritic syndrome ( a condition associated with post-streptococcal and rapidly progressing glomerulonephritis.
| |
| * Ureteral Pelvic Junction Obstruction (UPJ) is a rare condition beginning from birth in which the ureter is blocked between the kidney and bladder. This condition may cause blood in the urine.<ref>http://www.emoryhealthcare.org/departments/urology/sub_menu/upj.html</ref>
| |
| | |
| == Differential Diagnosis ==
| |
| | |
| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| |
| | |
| === Main Causes ===
| |
| * [[Bladder carcinoma]]
| |
| * Contamination during menstruation
| |
| * [[Cystitis]]
| |
| * [[Glomerulonephritis]]
| |
| * [[Prostatic hypertrophy]]
| |
| * [[Pyelonephritis]]
| |
| * [[Prostatitis]]
| |
| * [[Renal carcinoma]]
| |
| * [[renal stones|Stones]]
| |
| * [[Urinary Tract Infection]] ([[UTI]])
| |
| | |
| === Other Causes ===
| |
| * Acute/chronic [[Cystitis]]
| |
| * Acute intestinal [[nephritis]]
| |
| * [[Adenovirus]]
| |
| * After [[Endocarditis]]
| |
| * Allergic [[Granulomatosis]]
| |
| * [[Alport's Syndrome]]
| |
| * Analgesic kidney
| |
| * [[Arteriosclerosis]]
| |
| * [[Balkan Nephropathy]]
| |
| * [[Beeturia]]
| |
| * [[Benign familial hematuria]]
| |
| * [[Berger's Disease]]
| |
| * [[Bilharziosis]]
| |
| * Bladder infiltration
| |
| * Bladder [[tuberculosis]]
| |
| * [[Calyx Diverticulum]]
| |
| * [[Chemotherapeutics]]
| |
| * Consumption coagulopathy
| |
| * [[Crescentic glomerulonephritis]]
| |
| * Cystic kidneys
| |
| * [[Cytomegalovirus]] ([[CMV]])
| |
| * [[Dermatosclerosis]]
| |
| * [[Diabetes Mellitus]]
| |
| * Diabetic glomerulosclerosis/[[diabetic nephropathy]]
| |
| * [[Drug]]s
| |
| * [[ECHO viruses]] ('''E'''nteric '''C'''ytopathic '''H'''uman '''O'''rphan)
| |
| * [[E.coli]]
| |
| * [[Endometriosis]]
| |
| * [[Fabry's Disease]]
| |
| * Factor lack
| |
| * [[Filaria]]
| |
| * [[Fistula]]
| |
| * Focal glomerulotnephritis
| |
| * Foods
| |
| * Foreign body in urethra
| |
| * [[Goodpasture's Syndrome]]
| |
| * [[Heart failure]]
| |
| * Heavy exercise
| |
| * [[Hemoglobinopathy]]
| |
| * [[Hemophilia]]
| |
| * [[Hemolytic Uremic Syndrome]]
| |
| * [[Hemorrhage]] from bladder outlet
| |
| * [[Hemorrhage]] from urethra
| |
| * [[Hepatitis B]]
| |
| * [[Hydronephrosis]]
| |
| * [[Hypernephroma]]
| |
| * [[Hypertension]]
| |
| * [[Inflammation]]
| |
| * [[Influenza]]
| |
| * [[Injury]]
| |
| * Kidney [[Amyloidosis]]
| |
| * Kidney cell [[carcinoma]]
| |
| * Kidney [[tuberculosis]]
| |
| * [[Legionella]] Infection
| |
| * [[Systemic Lupus Erythematosus]]
| |
| * Malignant [[Hypertension]]
| |
| * [[Masturbation]]
| |
| * [[Meatus Stenosis]]
| |
| * [[Megaureter]]
| |
| * [[Membranoproliferative glomerulonephritis]]
| |
| * [[Metastases]]
| |
| * [[Mononucleosis]]
| |
| * [[Multiple Myeloma]]
| |
| * [[Mycoplasma]]
| |
| * [[Myoglobinuria]]
| |
| * [[Nail-Patella Syndrome]]
| |
| * [[Neoplasm]]
| |
| * [[Nephrocalcinosis]]
| |
| * [[Nephrolithiasis]]
| |
| * [[Osler's Disease]]
| |
| * [[Polyarteritis Nodosa]]
| |
| * [[Polycystic Kidney Disease]]
| |
| * [[Polycythemia Vera]]
| |
| * [[Porphyria]]
| |
| * [[Postinfectious glomerulonephritis]]
| |
| * [[Plasmodium]]
| |
| * Prostate [[adenoma]]
| |
| * [[Prostate carcinoma]]
| |
| * Prostate [[hyperplasia]]
| |
| * Prostate [[tuberculosis]]
| |
| * [[Pseudomonas]]
| |
| * [[Pyelonephritis]]
| |
| * Radiation nephropathy
| |
| * Renal artery aneurysm
| |
| * [[Renal cyst]]
| |
| * Renal [[hyperplasia]]
| |
| * Renal infarct
| |
| * Renal pelvis carcinoma
| |
| * [[Renal Stones]]
| |
| * Renal trauma
| |
| * Renal vein infarct
| |
| * [[Renal Vein Thrombosis]]
| |
| * [[Salmonella]]
| |
| * [[Sarcoidosis]]
| |
| * [[Schistosoma]]
| |
| * Schonlein-Henoch's Disease
| |
| * [[Shock]]
| |
| * Shunt nephritis
| |
| * [[Sickle Cell Anemia]]
| |
| * Sponge kidney
| |
| * [[Staphylococci]]
| |
| * [[Streptococci]]
| |
| * [[Thalassemia]]
| |
| * [[Thin Basement Membrane Disease]]
| |
| * Thrombocytopathies
| |
| * [[Thrombocytopenia]]
| |
| * [[Thrombotic Thrombocytopenic Purpura]]
| |
| * [[Toxin]]s
| |
| * [[Toxoplasma]]
| |
| * [[Trauma]]
| |
| * Traumatic kidney lesion
| |
| * [[Trichinella Spiralis]]
| |
| * [[Tubulointerstitial nephropathies]], [[nephritis]]
| |
| * [[Tumor]]
| |
| * [[Urate]] [[nephropathy]]
| |
| * [[Ureter]] [[carcinoma]]
| |
| * [[Ureter]] [[tuberculosis]]
| |
| * [[Urethra]] [[carcinoma]]
| |
| * [[Urethral]] [[carbuncle]]
| |
| * [[Urethral]] valves
| |
| * [[Urethritis]]
| |
| * Urethrolithiasis
| |
| * Urogential tuberculosis
| |
| * [[Urolithiasis]]
| |
| * [[Urothelium]] [[carcinoma]]
| |
| * [[Varicella]]
| |
| * Vesical calculi
| |
| * Vesico-ureteral-renal reflux
| |
| * [[Warfarin]] therapy (overdose)
| |
| * [[Wegener's Granulomatosis]]
| |
| * [[Wilms' Tumor]]
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
| | |
| [[ar:بول دموي]] | |
| [[de:Hämaturie]]
| |
| [[es:Hematuria]]
| |
| [[fr:Hématurie]]
| |
| [[it:Ematuria]]
| |
| [[he:המטוריה]]
| |
| [[ja:血尿]]
| |
| [[pt:Hematúria]]
| |
| [[qu:Yawar ispay]]
| |
| [[ru:Гематурия]]
| |
| [[fi:Verivirtsaisuus]]
| |
| [[zh:血尿]]
| |
| | |
| = Epidemiology and Demographics =
| |
| * 2.5% of the general population has asymptomatic hematuria
| |
| | |
| === Other Diagnostic Studies ===
| |
| * Three-tube test
| |
| * Centrifuge urine sample
| |
| * Urine cytology
| |
| * Urine cytoscopy
| |
| * Renal biopsy
| |
| | |
| | |
| = Treatment =
| |
| * Older patients with transient hematuria should be evaluated for urinary tract cancers
| |
| * Urologic consult if necessary
| |
| * Treat underlying etiologies
| |
| * Increase hydration (stones)
| |
| | |
| == Pharmacotherapy ==
| |
| | |
| === Acute Pharmacotherapies ===
| |
| * Antibiotics (UTI)
| |
| * Analgesics (stones)
| |
| | |
| == Surgery and Device Based Therapy ==
| |
| * Biopsy for patients for glomerular sources
| |
| | |
| == Acknowledgements ==
| |
| The content on this page was first contributed by {{CMG}}
| |
| | |
| <br>
| |
|
| |
|
| | ==Treatment== |
| | [[Hematuria medical therapy|Medical Therapy]] | [[Hematuria surgery|Surgery]] | [[Hematuria primary prevention|Primary Prevention]] | [[Hematuria cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hematuria future or investigational therapies|Future or Investigational Therapies]] |
|
| |
|
| | ==Case Studies== |
| | [[Hematuria case study one|Case#1]] |
|
| |
|
| [[Category:Nephrology]] | | [[Category:Nephrology]] |