HEMATURIA

Fakiha Maqsood
WHAT IS HEMATURIA

• Presence of blood cells in urine

• Hematuria is a sign, not a disease itself. It is an
indicator that requires us to investigate further
to try to determine the underlying cause
TYPES OF HEMATURIA

• GROSS

• MICROSCOPIC
 Gross hematuria occurs when there is
enough blood present in the urine that it is
visible to the naked eye. It can turn toilet
water a pale pink or bright red color.

Microscopic hematuria is a result of there

TYPES: being an amount of blood in the urine that

can only be seen through a microscope. It
consists of 3-5 RBC/High Power Field

Dipstick hematuria results when oxidation

of the urine test strip causes a color
change. It does not always mean that
blood cells are present in the urine.
 • infection ;
• cloudy, smelly, painful urination
• UTI, pyelonephritis, hepatitis

• misc ;
• Strenuous exercise

CAUSES OF • Fever
• toxins, contrast dyes

HEMATURIA • nonsteroidal anti-inflammatory drugs (NSAIDs),

• aspirin,
• blood thinners
• A medical procedure that physically involves part of the urinary tract, such as
surgery, a kidney biopsy, or inserting a urinary catheter, can cause temporary
bloody urine.
• injury to the kidney or bladder
 • inflammation ;
• blood in the urine and sometimes radiating pain, painful urination,
urinary urgency, and/or urinary hesitancy:
• Urethritis—inflammation of the duct that carries urine from the
bladder out of the body (urethra)
• Prostatitis—inflammation of the prostate (which surrounds the
urethra in men)

Causes • Benign prostatic hyperplasia (BPH)

• Kidney stones or bladder stones

• Diseases
• glomerulonephritis ; Ig A nephropathy, RPGN, post-infectious
glomerulonephritis
• Diabetes and high blood pressure (hypertension)
• Polycystic kidney disease
 • chronic/inherited disorder ;
• Bleeding disorders, haemophilia and
thrombocytopenia.
• Alport syndrome, an inherited condition associated
with hematuria and protein in the urine
• Autoimmune disorders
Causes
• cancer;
• Bladder cancer
• Kidney cancer
• Prostate cancer
 Differential Diagnosis

One of the questions to Reddish-brown coloring can also
come from eating foods such as
be asked is whether or beets or taking drugs such as
not it is really blood that phenazopyridine (most commonly),
and also methyldopa,
is present and/or seen in phenolphthalein, phenothiazine, etc.
the urine.
Hemoglobin in the urine
(hemoglobinuria). Hemolytic
anemias, including sickle cell anemia
for example, can lead to
hemoglobinuria.
bilirubin is usually removed by the
liver but can accumulate when the
liver is damaged or diseased and can
cause urine to be a dark amber color.
Another example is myoglobin, a
small, oxygen-binding protein found
in heart and skeletal muscles,
eliminated in the urine. High levels of
myoglobin can give urine a red color.
 • Many people with hematuria will not have any
other signs or symptoms. Those who do typically
have symptoms associated with the underlying
condition. Some common examples include:
• Painful urination
• Frequent and/or urgent urination
Signs and • Abdominal and/or back pain
symptoms • Urinary hesitancy (interruption in flow, difficulty
with urination)
• Fever (with infections)
• Swelling of the feet, ankles and/or legs (edema)
• Severe pain (with kidney stones)
 • Onset of urination (initial hematuria)–urethra or prostate
(men)
• Throughout urination (total hematuria)–bladder, ureter, or
kidneys
• End of urination (terminal hematuria)–bladder or prostate
(men)

Diagnosis
• Phase contrast microscopy: A careful examination of the
urine for the presence of a significant number of
dysmorphic RBCs suggests a renal (glomerular) source of
the hematuria. A urine sample that predominantly
contains eumorphic RBCs suggests an extrarenal
(nonglomerular) source.
 • Symptoms may indicate the site and/or cause of
bleeding:
• Abdominal pain–inflammation of the kidney or
ureter caused by trauma, infection, or tumor
• Decreased urinary force, hesitancy, or incomplete
voiding–lower urinary tract, benign prostate
Diagnosis hyperplasia (BPH, enlarged prostate), tumor
• Fever–infection, typically kidney infection, prostate
infection, or urethral infection
• Pain in the flank–kidney trauma or tumor
• Urinary urgency, pain, or frequency–bladder cancer
 • The physician takes a complete personal and family medical history. The
personal history can provide useful information:
• Drinking and smoking history
• Exposure to toxic substance dating back 25 years or more
• History of kidney stones

History and • Injuries and infections

• Recent and past drug use

examinatio • Recent illness

• Sexually transmitted disease (STD) exposure
n • Urinary habits
• The family history may reveal inherited predispositions to kidney stone
disease, sickle cell anemia, von Hippel-Lindau disease, or another genetic
disorder associated with hematuria.
• A thorough physical examination is performed, with emphasis on the
urinary tract, abdomen, pelvis, genitals, and rectum.
 • Urinalysis—this is typically the first test performed and the primary means by which
hematuria is detected or confirmed. It consists of visual and chemical examinations
that can identify gross hematuria based upon the color of the urine and by a positive
finding on a chemical test strip. If there are abnormal findings, then a microscopic
examination is performed. Multiple urine samples may be tested. According to the
American Urological Association, microscopic hematuria is defined as more than 3 red
blood cells seen per high powered (microscope) field (rbc/hpf) on two of three urine
samples. Other findings from a urinalysis, such as the presence of protein in the urine,
may give clues to the cause.
• Blood tests for creatinine and urea nitrogen (BUN)—performed to evaluate kidney
function; these may be ordered as part of a basic metabolic panel (BMP) or

Hematuria
comprehensive metabolic panel (CMP).
• Complete blood count (CBC)—to evaluate blood cells and platelets; may be ordered as
a general evaluation of health or when anemia, infection, or a blood cell abnormality

tests
is suspected.

• Possible follow-up testing to further evaluate health of the kidneys and their function:

• Urine protein or urine albumin (microalbumin)

• Estimated glomerular filtration rate (eGFR) and/or rarely a creatinine clearance
• Cystatin C—may be used as an alternative to the blood creatinine test and to calculate
eGFR
• Urine culture—performed to identify a bacterial infection when suspected
• Urine cytology—performed to look for and identify abnormal cells in the urine
 • Depending on initial test results, as well as your signs, symptoms, physical
examination and medical history, some other tests may be ordered to help
further investigate the underlying cause of blood in your urine. These tests
are not routine and typically done only when indicated. Some examples
include:

• Kidney stone analysis—to evaluate the composition of a kidney stone that

has been passed into the urine; this test is performed on the stone itself.
• Bleeding disorder tests—including coagulation tests such as PT and PTT

Tests • Sickle cell tests—to determine if the source of hemoglobinuria is sickle cell
disease
• Hemoglobinopathy evaluation—to identify other inherited disorders
affecting red blood cells
• Autoantibody testing, such as ANA, for autoimmune disorders
• Prostatic specific antigen (PSA)—to help identify prostate cancer
• Kidney biopsy—sometimes used to help determine the nature and extent of
structural damage to a kidney
 Non Laboratory Tests

Imaging tests and other Cystoscopy Abdominal ultrasound CT scan Magnetic resonance Voiding
Non- procedures are imaging (MRI) cystourethrography
Laboratory sometimes performed to
identify abnormalities,
Tests kidney damage, kidney
obstructions, tumors, and
cancers. Examples
include:

Radionuclide studies
TREATMENT

Depending on the condition causing your hematuria, follow up after treatment to ensure there's no more
treatment might involve taking antibiotics to clear a blood in your urine.
urinary tract infection, trying a prescription
medication to shrink an enlarged prostate or having
shock wave therapy to break up bladder or kidney
stones. In some cases, no treatment is necessary.