Hematuria. Causes and symptoms of hematuria in children. Treatment of hematuria

About hematuria

Hematuria is the appearance of red blood cells (red blood cells) in the urine.
At the same time, the urine changes color to a reddish-brown, dark, comparable to the color of tea, coffee, or classically defined as the “color of meat slop.” Hematuria is a symptom of many dangerous diseases, so this sign is a reason to immediately consult a doctor. If the color of urine differs significantly from normal, and small blood clots can be detected by eye, we speak of gross hematuria. If the number of red blood cells in the urine exceeds the norm slightly and is detected during examination, this is called microhematuria. We must remember that urine does not always change color solely due to blood getting into it. Eating foods rich in food dyes, beets, and taking certain medications can cause such coloring. A woman may mistake the mixing of urine with menstrual blood from the vagina for hematuria , which, of course, cannot speak of pathology.

FAQ

How is hematuria diagnosed?

Blood in the urine is detected during a general urine test. Since it does not represent a ready-made diagnosis, the causes of hematuria need to be further clarified.

Is hematuria dangerous?

Blood in the urine may be a sign of life-threatening diseases, such as acute glomerulonephritis or kidney cancer. Therefore, the doctor will definitely prescribe additional tests that will help in making a diagnosis.

How does pediatric hematuria differ from adult hematuria?

It is not the phenomenon itself that is different, but its possible causes. Chronic hematuria that occurs in a young child leads the doctor to believe that the cause may be a congenital pathology. However, its risk is minimal: in most cases, blood in the urine in both children and adults is associated with infectious diseases of the kidneys, bladder and urethra.

Types of hematuria

There are three types of hematuria, depending on at what stage of urination atypically colored urine appears. Initial, or initial hematuria is the appearance of blood in the first portion of urine at the beginning of urination. Indicates damage to the urethra. Terminal or final hematuria - blood appears in the last portion of urine at the end of urination. More often occurs with cystitis or urolithiasis with the presence of stones in the bladder. Total or complete hematuria means that the entire volume of urine excreted is uniformly stained with blood. The source of bleeding can be located in any part of the urinary tract.

If large blood clots appear in the urine, this indicates bleeding from the kidney or renal pelvis, or from the bladder.

Hematuria may occur unexpectedly and not be accompanied by a deterioration in the patient’s general condition or the appearance of pain.

Painless hematuria is common with bladder tumors. If the appearance of blood in the urine is combined with pain and burning when urinating or with pain in the lower abdomen and lumbar region, this may indicate inflammatory diseases, renal colic, or the presence of a kidney tumor.

Diagnostic methods

In order not to make a mistake in the diagnosis, the attending physician - a nephrologist or urologist - will prescribe a number of clarifying tests, including a general blood test, sediment microscopy according to Nicheporenko, creatinine level, concentration of sodium, calcium and potassium in the blood serum.

Additionally, the patient is sent for studies that visualize the kidneys and urinary tract: urography, CT, cystoscopy. Men may be prescribed an ultrasound of the prostate, and women may be prescribed an ultrasound of the pelvic organs.

An important role is played by collecting anamnesis: clarifying symptoms (where the pain is located and how severe it is), lifestyle and hereditary factors.

Hematuria in children: difficulties in making a diagnosis

Determining the causes of blood in a child’s urine has its own characteristics. In a conversation with the parents, the doctor finds out when hematuria was first noted in the tests. Early appearance of blood indicates a congenital pathology. Suspicions are aggravated if the child has chronic hematuria.

An important diagnostic sign that helps the doctor make a diagnosis is the combination of hematuria and proteinuria (protein in the urine) in the analysis. It confirms that the source of the blood is a kidney disorder.

Causes of hematuria

The appearance of hematuria always indicates the presence of pathology in the urinary system . Urolithiasis, when a stone is found in the ureter or bladder, is in most cases accompanied by hematuria. With traumatic injury to the kidneys, ureters, bladder or urethra (in the latter case, the presence of a foreign body is possible), hematuria appears with a high probability.

The presence of infection and the diseases caused by it (cystitis, urethritis, glomerulonephritis, pyelonephritis, tuberculosis of the kidneys and urinary tract and others) often have hematuria among other symptoms. Tumors in different parts of the genitourinary system cause hematuria in a large percentage of cases. Sometimes hematuria occurs due to metabolic disorders and blood diseases.

Who is more likely to develop hematuria?

People more likely to develop hematuria may have:

• enlarged prostate
• urinary stones
• take certain medications, including blood thinners, aspirin and other pain relievers, and antibiotics
• do strenuous exercise such as long-distance running
• have a bacterial or viral infection such as streptococcus or hepatitis
• have a family history of kidney disease
• have a disease or condition that affects one or more organs

Treatment of hematuria

Since hematuria is not a separate disease, but only a symptom of one of the above, medical measures are aimed at recognizing the main cause that caused the appearance of blood in the urine. A full diagnostic examination is carried out. It includes laboratory methods: general blood and urine tests, biochemical blood test and blood test for clotting factors, Nechiporenko urine analysis, microscopic examination of detected red blood cells and bacteriological urine culture to detect infections.

Instrumental and X-ray examinations - ultrasound of all parts of the genitourinary system and intravenous urography are also mandatory. In addition, to exclude a bladder tumor, cystoscopy is indicated - a special endoscopic examination, examination of the mucous membrane of the urethra and bladder using a cystoscope. Women should undergo a gynecological examination. A consultation and examination by a proctologist is also recommended.

Specialists at the DeVita clinic will take all necessary measures to quickly determine the causes of hematuria and begin treatment for the identified disease.

Diagnosis of hematuria

To determine the exact cause of hematuria, a number of studies must be carried out. Most often, they consult a doctor when elevated red blood cells are detected during a regular medical examination. Currently, patients with hematuria are referred to a urologist, sometimes to a nephrologist, for a complete examination.

Timely and thorough diagnosis is of great importance, since delay in treatment can lead to serious consequences.

Most often, the following examination is prescribed to identify the cause of hematuria:

• examination of the urinary tract (cystoscopy);
• computed tomography (X-ray) or ultrasound.

The purpose of diagnosis is to determine the presence of stones, possibly tumors.

Cystoscopy is a diagnostic method based on the use of a small telescopic device that is inserted through the urethra. This procedure takes place on an outpatient basis using local anesthesia.

Additionally you will need to submit:

• general analysis of urine and blood;
• specific urine test;
• analysis for red blood cells, etc.

Consultation with related specialists (oncologists, gynecologists, etc.) may be required.

Sometimes even a thorough examination does not allow one to determine the exact cause of hematuria, which is quite common. In some patients, hematuria may persist for a long time and requires constant medical supervision.

To protect yourself from microhematuria, you need to:

• Avoid hypothermia.
• Get medical examinations regularly.
• Avoid injury to the abdominal area.

There are often cases when urine turns red due to a diet disorder, poisoning, acute intoxication, etc.

Cost of services

List of used literature

1. Nikolaev A. Yu., Shcherbin A. A. et al. The mechanism of hematuria in hematuric nephritis // Ter. archive, 1988, No. 6, p. 34–37.
2. Burtsev V.I., Turchina L.P. Hematuria // Clinical Medicine, 1997, No. 6, p. 66–69.
3. Pediatric nephrology [Text]: practical work. hands / ed. E. Loyman, A. N. Tsygin, A. A. Sarkisyan. - Moscow: Litterra, 2010. - 400 p.
4. Urolithiasis disease. Modern methods of diagnosis and treatment [Text] / Yu. G. Alyaev [etc.]; edited by Yu. G. Alyaeva. - Moscow: GEOTAR-Media, 2010. - 224 p. : ill. - (B-specialist doctor).

How to detect hematuria?

Visible hematuria often bothers patients and forces them to see a doctor.

Microhematuria is determined by microscopy of urine sediment.

What tests are needed to make a diagnosis?

Any patient with gross hematuria or significant microhematuria should undergo a comprehensive evaluation of the urinary tract. The first step is a thorough history and physical examination. Next, a laboratory urine test and examination of the urinary sediment under a microscope are performed. The urine is tested for protein (a sign of kidney disease) and urinary tract infections. The number of red blood cells in the urine (erythrocyturia) and the content of leukocytes in the urine (leukocyturia) are determined. A urine cytology test is needed to check for abnormal cells. Laboratory blood tests are performed to measure serum creatinine levels (kidney function tests).

Patients with significant protein in the urine or elevated creatinine levels should undergo additional testing to rule out kidney disease.

A complete urologic examination in patients with hematuria also includes x-rays of the kidneys, ureters, and bladder (an overview of the urinary system) to rule out masses and stones. Excretory urography is performed - a method for determining kidney function, based on the introduction of radiopaque agents into the bloodstream, followed by radiography and determination of the release of dye by the kidneys.

Many doctors may choose other imaging tests, such as computed tomography (CT) or multislice computed tomography (MSCT). These methods are preferred and more informative for assessing the condition of the kidneys, and are also the best methods for assessing urinary stones. Recently, many urologists have been using CT urography. This allows the urologist to look at the kidneys and evaluate the condition of the ureters as a result of a single x-ray. In patients with elevated creatinine levels or allergies to radiocontrast agents, magnetic resonance imaging (MRI) or retrograde pyelography is performed to evaluate the upper urinary tract. During retrograde pyelography, the patient is taken to the operating room, a radiopaque contrast agent is injected into the kidney through a ureteral catheter, followed by radiography.

Patients with hematuria undergo cystoscopy under local anesthesia using a rigid, or more often, flexible instrument - a cystoscope. After anesthesia, a cystoscope is inserted through the urethra into the bladder and the bladder and urethra are assessed for the presence of masses.

What to do if there was or is hematuria, but no cause was found as a result of the examination?

In at least 8-10 percent of cases, no cause for hematuria is found. Some studies have shown an even higher percentage of patients without a cause. Unfortunately, we have to admit that the same studies later showed that 3 percent of patients were later diagnosed with malignant tumors of the urinary system.

Thus, there is a risk of underexamining the patient or failing to determine the initial stages of some formations. There are no recommendations for subsequent comprehensive examination. Also, there is still no consensus among urologists on this topic.

It is still recommended to consider repeating urine and cytology tests at 6, 12, 24 and 36 months. In the case of repeated gross hematuria, a positive result of urine cytology, or the appearance of irritating urinary symptoms such as pain during urination or frequent urination, an immediate reassessment of the condition of the urinary system is carried out with cystoscopy and repeated radiological diagnostic methods. If none of these symptoms are detected within three years, no further urological examination is required.

Diagnostics and necessary examinations

If red blood cells are detected in urine, you should contact a physician, urologist or gynecologist. After a preliminary examination and medical history, the doctor will in any case refer you to a specialist, if necessary. NeoMed performs comprehensive diagnostics to find the underlying causes of hematuria.

• Urinalysis and examination of urinary sediment.
• General and biochemical blood tests to identify provoking diseases and anemia.
• Urography is an x-ray examination of the kidneys and urinary tract; a contrast agent is injected for better visualization. Helps identify neoplasms, stones, and foci of inflammation.
• Cystoscopy is an endoscopic examination of the bladder through the urethra. Allows you to non-surgically detect an obvious source of bleeding, urolithiasis, neoplasms, polyps, and inflammatory processes. If necessary, a puncture is performed.
• Computed tomography of the kidneys and urinary tract, other organs, if there is a suspicion of a source of bleeding. Identifies pathological processes and consequences of injuries.
• MRI of the genitourinary system. Detects neoplasms, stones, advanced forms of STDs, hernias, pathologies of organ structure.

Treatment is aimed at eliminating the cause. In some cases, no therapy is required at all; in others, medication or surgery cannot be avoided. The medical office has everything for diagnosing hematuria and treating provoking diseases; call and they will make an appointment with the right specialist.

What diseases are accompanied by blood in the urine

Signs of gross hematuria are visible to the naked eye. The color of the urine can range from pale pink to dark brown, or bloody clots or inclusions may be present in undissolved form. This condition has many causes:

• Oncology is the most unpleasant factor. Blood clots in the urine indicate tumors in the bladder or urinary tract.
• Kidney bleeding - red or brown urine with the presence of bloody clots.
• Inflammatory kidney diseases: pyelonephritis and glomerulonephritis - red or burgundy urine.
• Kidney injuries - the degree of staining depends on the intensity of bleeding.
• Bladder endometriosis – bloody urine appears during menstruation.
• Urolithiasis - stones cause injuries of varying intensity. The larger the stone, the higher the number of red blood cells in the urine.

Other diseases also lead to gross hematuria: cystitis, urethritis, prostatitis, prostate adenoma, gynecological problems.

If blood is detected in the urine during laboratory tests, the cause may be kidney disease, malignant and benign formations of the genitourinary system, connective tissue pathologies, diabetes mellitus, gout, and infections.

You should not select a diagnosis yourself; only diagnosis can determine the danger and urgency of treatment.