Urine: hematuria

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Introduction

  • A clinical sign NOT a diagnosis.
  • The presence of blood in urine micro- or macroscopically.
  • Cause : several: urinary tract infection, urolithiasis, neoplasia, drug toxicity, urethral defects, exercise, systemic diseases, trauma.
  • Signs : discolored urine (macroscopic) - variable other signs depending on cause.
  • Diagnosis : urinalysis, blood biochemistry/hematology, rectal palpation, endoscopy, ultrasonography.
  • Treatment : depends upon specific etiology.
  • Prognosis : depends upon specific etiology.

Diagnosis

Differential diagnosis

  • Hemoglobinuria.
  • Myoglobinuria.
  • Urine discoloration due to drugs/chemicals.

Diagnosis

Clinical signs

  • The timing of hematuria may reflect origin of blood:
    • Throughout urination consistent with hemorrhage from kidneys, ureters or bladder.
    • At beginning and end of urination may be associated with lesions in the distal and proximal urethra, respectively.
Urinary tract infection
  • Upper tract infection may   →   pyrexia, weight loss and anorexia.
  • Lower tract infections, especially cystitis, manifest as stranguria or polliakiuria    .
    Obstructive disease
  • Signs of renal colic or painful urination (stranguria, pollakiuria) .
    Urethral defects
  • Urine not discolored.
  • Void urine normally but at the end of urination a series of urethral contractions result in passage of squirts of fresh blood.
  • Rarely causes dysuria or pollakiuria.
    Exercise-associated
  • Hematuria/myoglobinuria immediately post-exercise.
    Systemic diseases
  • Clinical signs of specific diease, eg coagulopathies  [Disseminated intravascular coagulation]  , liver disease    , hemolytic anemia    , exercise-induced rhabdomyolysis    .
    Idiopathic renal hematuria
  • Severe spontaneous hematuria in the absence of other signs of disease.
  • Death can occur.
  • Signs consistent with acute blood loss, eg tachypnea/tachycardia, pale mucous membranes.

Outcomes

Prognosis

  • Depends upon underlying cause.

Expected response to treatment

  • Resolution of blood in urine.

Reasons for treatment failure

  • Incorrect diagnosis.
  • Inappropriate treatment.
  • Recurrence of lesion/problem.
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