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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
{{Infobox_Disease |
  Name          = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB    = 19635 |
  ICD10          = {{ICD10|N|02||n|00}}, {{ICD10|R|31||r|30}} |
  ICD9          = {{ICD9|599.7}}, {{ICD9|791.2}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  MeshID        = D006417 |
}}
{{Hematuria}}
{{Hematuria}}
{{SCC}}
'''For patient information, click [[{{PAGENAME}} (patient information)|here]]'''
{{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.
 
== Types of Hematuria==
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==
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 ==
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.
 
In older patients, [[cystoscopy]] with [[biopsy]] of suspected lesions is often employed to investigate for [[bladder cancer]].
 
* [[Urinalysis]] for all patients
* [[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:
* 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 ==
Common causes of ''macroscopic hematuria/ haematuria'' (i.e. blood visible in the urine) include:
* [[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 ==
{{SCC}}; {{AE}}{{VSKP}} {{AIDA}}


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>
{{SK}} Haematuria; urinary tract bleeding; blood in urine<br><br>'''To view a comprehensive algorithm of common findings of urine composition and urine output, click [[Urine#Algorithm of Common Urinary Findings|here]]'''<br>


=== Main Causes ===
==[[Hematuria overview|Overview]]==
* [[Bladder carcinoma]]
* Contamination during menstruation
* [[Cystitis]]
* [[Glomerulonephritis]]
* [[Prostatic hypertrophy]]
* [[Pyelonephritis]]
* [[Prostatitis]]
* [[Renal carcinoma]]
* [[renal stones|Stones]]
* [[Urinary Tract Infection]] ([[UTI]])


=== Other Causes ===
==[[Hematuria definition|Definition]]==
* 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==
==[[Hematuria classification|Classification]]==
{{reflist|2}}


[[ar:بول دموي]]
==[[Hematuria causes|Causes]]==
[[de:Hämaturie]]
{{Seealso|Microscopic hematuria#Causes}}
[[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 =  
==[[Hematuria differential diagnosis|Differentiating Hematuria from other Diseases]]==
* 2.5% of the general population has asymptomatic hematuria


=== Other Diagnostic Studies ===
==[[Hematuria epidemiology and demographics|Epidemiology and Demographics]]==
* Three-tube test
* Centrifuge urine sample
* Urine cytology
* Urine cytoscopy
* Renal biopsy


==[[Hematuria risk factors|Risk Factors]]==


= Treatment =
==[[Hematuria natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
* Older patients with transient hematuria should be evaluated for urinary tract cancers
* Urologic consult if necessary
* Treat underlying etiologies
* Increase hydration (stones)


== Pharmacotherapy ==
==Diagnosis==
 
[[Hematuria diagnostic evaluation| Diagnostic Evaluation]] | [[Hematuria history and symptoms| History and Symptoms]] | [[Hematuria physical examination | Physical Examination]] | [[Hematuria laboratory findings|Laboratory Findings]] | [[Hematuria cytoscopy|Cytoscopy]] | [[Hematuria CT|CT]] |  [[Hematuria ultrasound|Ultrasound]] | [[Hematuria other imaging findings|Other Imaging Findings]] | [[Hematuria other diagnostic studies|Other Diagnostic Studies]]
=== 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]]
[[Category:Urology]]
[[Category:Urology]]
[[Category:Emergency medicine]]
[[Category:Urologic Disease]]
[[Category:Urologic Disease]]
[[Category:Signs and symptoms]]
[[Category:Primary care]]
[[Category:Emergency medicine]]


[[pl:Hematuria]]
[[pl:Hematuria]]


 
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Revision as of 00:40, 25 June 2018

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Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [1] Aida Javanbakht, M.D.

Synonyms and keywords: Haematuria; urinary tract bleeding; blood in urine

To view a comprehensive algorithm of common findings of urine composition and urine output, click here

Overview

Definition

Classification

Causes

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Differentiating Hematuria from other Diseases

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Diagnostic Evaluation | History and Symptoms | Physical Examination | Laboratory Findings | Cytoscopy | CT | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

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