Hematuria
Encyclopedia
In medicine
, hematuria, or haematuria, is the presence of red blood cells (erythrocytes) in the urine
. It may be idiopathic
and/or benign
, or it can be a sign that there is a kidney stone
or a tumor
in the urinary tract (kidney
s, ureter
s, urinary bladder
, prostate
, and urethra
), ranging from trivial to lethal. If white blood cells are found in addition to red blood cells, then it is a signal of urinary tract infection.
Occasionally "hemoglobinuria
" is used synonymously, although more precisely it refers only to hemoglobin
in the urine.
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 CT scanning is more precise.
In older patients, cystoscopy
with biopsy
of suspected lesions is often employed to investigate for bladder cancer
.
If combined with pain, it may be loin pain hematuria syndrome.
Per AUA (American Urologic Association) guidelines, the following should be performed for high-risk patients with significant microhematuria (greater than three red blood cells per high-powered field):
Other, less common causes of hematuria include:
Rare causes include:
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, hematuria, or haematuria, is the presence of red blood cells (erythrocytes) in the urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
. It may be idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
and/or benign
Benignity
Benignity [from Latin benignus , from bonus + genus ] is a medical term used to describe a condition that is harmless...
, or it can be a sign that there is a kidney stone
Kidney stone
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
or a tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
in the urinary tract (kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
s, ureter
Ureter
In human anatomy, the ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually long and ~3-4 mm in diameter....
s, urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
, prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
, and urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
), ranging from trivial to lethal. If white blood cells are found in addition to red blood cells, then it is a signal of urinary tract infection.
Occasionally "hemoglobinuria
Hemoglobinuria
In medicine, hemoglobinuria or haemoglobinuria is a condition in which the oxygen transport protein hemoglobin is found in abnormally high concentrations in the urine. The condition is often associated with hemolytic anemia, in which red blood cells are destroyed, thereby increasing levels of free...
" is used synonymously, although more precisely it refers only to hemoglobin
Hemoglobin
Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...
in the urine.
Types
Red discoloration of the urine can have various causes:- Red blood cellRed blood cellRed blood cells are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen to the body tissues via the blood flow through the circulatory system...
s- Microscopic hematuriaMicroscopic hematuriaMicroscopic hematuria is a medical condition in which urine contains small amounts of blood. Blood quantity is too low to change the color of the urine...
(small amounts of blood, can be seen only on urinalysisUrinalysisA urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
or light microscopy) - Macroscopic hematuria (or "frank" or "gross") hematuria
- Microscopic hematuria
- HemoglobinHemoglobinHemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...
(only the red pigment, not the red blood cellRed blood cellRed blood cells are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen to the body tissues via the blood flow through the circulatory system...
s) - Other pigments
- MyoglobinMyoglobinMyoglobin is an iron- and oxygen-binding protein found in the muscle tissue of vertebrates in general and in almost all mammals. It is related to hemoglobin, which is the iron- and oxygen-binding protein in blood, specifically in the red blood cells. The only time myoglobin is found in the...
in myoglobinuriaMyoglobinuriaMyoglobinuria is the presence of myoglobin in the urine, usually associated with rhabdomyolysis or muscle destruction. Myoglobin is present in muscle cells as a reserve of oxygen.-Causes:... - PorphyrinPorphyrinPorphyrins are a group of organic compounds, many naturally occurring. One of the best-known porphyrins is heme, the pigment in red blood cells; heme is a cofactor of the protein hemoglobin. Porphyrins are heterocyclic macrocycles composed of four modified pyrrole subunits interconnected at...
s in porphyriaPorphyriaPorphyrias are a group of inherited or acquired disorders of certain enzymes in the heme bio-synthetic pathway . They are broadly classified as acute porphyrias and cutaneous porphyrias, based on the site of the overproduction and accumulation of the porphyrins... - BetaninBetaninBetanin, or Beetroot Red, is a red glycosidic food dye obtained from beets; its aglycone, obtained by hydrolyzing away the glucose molecule, is betanidin. As a food additive, its E number is E162. Betanin degrades when subjected to light, heat, and oxygen; therefore, it is used in frozen products,...
, after eating beetBeetThe beet is a plant in the Chenopodiaceae family which is now included in Amaranthaceae family. It is best known in its numerous cultivated varieties, the most well known of which is the purple root vegetable known as the beetroot or garden beet...
s - Drugs such as RifampicinRifampicinRifampicin or rifampin is a bactericidal antibiotic drug of the rifamycin group. It is a semisynthetic compound derived from Amycolatopsis rifamycinica ...
and PhenazopyridinePhenazopyridinePhenazopyridine is a chemical which, when excreted into the urine, has a local analgesic effect. It is often used to alleviate the pain, irritation, discomfort, or urgency caused by urinary tract infections, surgery, or injury to the urinary tract...
- Myoglobin
Diagnosis
Often, the diagnosis is made on the basis of the medical history and some blood testBlood test
A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
s—especially in young people in whom the risk of malignancy is negligible and the symptoms are generally self-limited.
Ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
investigation of the renal tract is often used to distinguish between various sources of bleeding. X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s can be used to identify kidney stone
Kidney stone
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
s, although CT scanning is more precise.
In older patients, cystoscopy
Cystoscopy
Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...
with biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
of suspected lesions is often employed to investigate for bladder cancer
Bladder cancer
Bladder cancer is any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis...
.
If combined with pain, it may be loin pain hematuria syndrome.
Per AUA (American Urologic Association) guidelines, the following should be performed for high-risk patients with significant microhematuria (greater than three red blood cells per high-powered field):
- Upper tract imaging of which a CTComputed tomographyX-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
urogram is the gold standard - Urine cytology
- CystoscopyCystoscopyCystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...
Causes
The most common causes of hematuria are:- Urinary tract infectionUrinary tract infectionA urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
with viruses, other sexually transmitted diseaseSexually transmitted diseaseSexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
s (particularly in women) or some bacterial species including strains of EPEC and Staphylococcus saprophyticusStaphylococcus saprophyticusStaphylococcus saprophyticus is a coagulase-negative species of Staphylococcus bacteria. S. saprophyticus is often implicated in urinary tract infections. S. saprophyticus is resistant to the antibiotic novobiocin, a characteristic that is used in laboratory identification to distinguish it from S... - Kidney stones or ureter stones
- Benign prostatic hyperplasiaBenign prostatic hyperplasiaBenign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
, in older men, especially those over 50
Other, less common causes of hematuria include:
- IgA nephropathyIgA nephropathyIgA nephropathy is a form of glomerulonephritis...
("Berger's disease") - occurs during viral infections in predisposed patients - Trauma (e.g., a blow to the kidneys)
- Tumors and/or cancer in the urinary system, for example bladder cancerBladder cancerBladder cancer is any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis...
or renal cell carcinomaRenal cell carcinomaRenal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule, the very small tubes in the kidney that filter the blood and remove waste products. RCC is the most common type of kidney cancer in adults, responsible for approximately 80% of cases... - Kidney diseases
- Urinary SchistosomiasisSchistosomiasisSchistosomiasis is a parasitic disease caused by several species of trematodes , a parasitic worm of the genus Schistosoma. Snails often act as an intermediary agent for the infectious diseases until a new human host is found...
(caused by Schistosoma haematobiumSchistosoma haematobiumSchistosoma haematobium is an important digenetic trematode, and is found in the Middle East, India, Portugal and Africa. It is a major agent of schistosomiasis; more specifically, it is associated with urinary schistosomiasis....
) - a major cause for hematuria in many African and Middle-Eastern countries; - Prostate infection or inflammation (prostatitisProstatitisProstatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
)
Rare causes include:
- Benign familial hematuriaThin basement membrane diseaseThin basement membrane disease is, along with IgA nephropathy, the most common cause of asymptomatic hematuria. The only abnormal finding in this disease is a thinning of the basement membrane of the glomeruli in the kidneys...
- Paroxysmal nocturnal hemoglobinuriaParoxysmal nocturnal hemoglobinuriaParoxysmal nocturnal hemoglobinuria , sometimes referred to as Marchiafava-Micheli syndrome, is a rare, acquired, potentially life-threatening disease of the blood characterised by complement-induced intravascular hemolytic anemia , red urine and thrombosis...
- a rare diseaseRare diseaseA rare disease, also referred to as an orphan disease, is any disease that affects a small percentage of the population.Most rare diseases are genetic, and thus are present throughout the person's entire life, even if symptoms do not immediately appear...
where hemoglobinHemoglobinHemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...
of hemolyzedHemolysisHemolysis —from the Greek meaning "blood" and meaning a "loosing", "setting free" or "releasing"—is the rupturing of erythrocytes and the release of their contents into surrounding fluid...
cells is passed into the urine. - Sickle cell traitSickle cell traitSickle cell trait describes a condition in which a person has one abnormal allele of the hemoglobin beta gene , but does not display the severe symptoms of sickle cell disease that occur in a person who has two copies of that allele...
can precipitate large amounts of red blood cell discharge, but only a small number of individuals endure this problem - Arteriovenous malformationArteriovenous malformationArteriovenous malformation or AVM is an abnormal connection between veins and arteries, usually congenital. This pathology is widely known because of its occurrence in the central nervous system, but can appear in any location. An arteriovenous malformation is a vascular anomaly. It is a...
of the kidney (rare, but may impress like renal cell carcinoma on scans as both are highly vascular) - Nephritic syndromeNephritic syndromeNephritic syndrome is a collection of signs associated with disorders affecting the kidneys, more specifically glomerular disorders. It is characterized by having small pores in the podocytes of the glomerulus, large enough to permit proteins and red blood cells to pass into the urine...
(a condition associated with post-streptococcal and rapidly progressing glomerulonephritisGlomerulonephritisGlomerulonephritis, also known as glomerular nephritis, abbreviated GN, is a renal disease characterized by inflammation of the glomeruli, or small blood vessels in the kidneys...
). - Fibrinoid necrosisFibrinoid necrosisFibrinoid necrosis is a form of necrosis, or tissue death, in which there is accumulation of amorphous, basic, proteinaceous material in the tissue matrix with a staining pattern reminiscent of fibrin. It is associated with conditions such as immune vasculitis Fibrinoid necrosis is a form of...
of the Glomeruli (as a result of malignant hypertension) - Vesical varices may rarely develop secondary to obstruction of the inferior vena cavaInferior vena cavaThe inferior vena cava , also known as the posterior vena cava, is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart....
. - AllergyAllergyAn Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
may rarely cause episodic gross hematuria in children. - Left renal veinRenal veinThe renal veins are veins that drain the kidney. They connect the kidney to the inferior vena cava.It is usually singular to each kidney, except in the condition "multiple renal veins".It also divides into 2 divisions upon entering the kidney:...
hypertensionHypertensionHypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, also called "nutcracker phenomenon" or "nutcracker syndrome," is a rare vascular abnormality responsible for gross hematuria. - 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.
- March hematuriaMarch hematuriaMarch hemoglobinuria, also known as march hematuria, occurs when blood is seen in the urine after repetitive impacts on the body, particularly affecting the feet and hands...
secondary to repetitive impacts on the body, usually the feet - Athletic nephritis secondary to strenuous exercise
- Medications can cause red discoloration of the urine, but not hematuria. Some examples include: sulfonamides, quinineQuinineQuinine is a natural white crystalline alkaloid having antipyretic , antimalarial, analgesic , anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine which, unlike quinine, is an anti-arrhythmic...
, rifampin, phenytoinPhenytoinPhenytoin sodium is a commonly used antiepileptic. Phenytoin acts to suppress the abnormal brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage-gated sodium channels...