General analysis of urine with sediment microscopy. Blood in the urine of a child

Introduction

The appearance of noticeable traces of blood in the urine or the detection of an increased level of red blood cells in the general analysis of urine deserve serious attention.

In 4% of men and women with elevated red blood cells in the urine and in almost 40% of patients with visible traces of blood in the urine, the cause of the problem is kidney cancer, cancer Bladder or cancer of another area of ​​the urinary tract. In many cases, the appearance of blood/erythrocytes in the urine is the first and only symptom of the presence of a malignant tumor.

In this regard, all patients who do not have other obvious reasons that can cause the penetration of blood / erythrocytes into the urine, examination is recommended to rule out or early diagnosis of cancer.

In this article, we will provide answers to the following questions:

1. Can a change in the color of urine be due NOT to bleeding, but to some other reason?
2. In what cases should the appearance of traces of blood or an increased level of red blood cells in the urine be considered a possible sign of a tumor?
3. What examination should be done if the cause of the appearance of blood or red blood cells in the urine is unknown?

Can a change in the color of urine be associated not with bleeding, but with some other reason?

Depending on the color of the urine and the severity of the bleeding, the presence of blood can give the urine different shades, from light pink to dark brown.

However, not only blood, but also some medicines and foodstuffs can give the same color to urine. You can find a list of them in an article on the change in the normal color of urine.

If, after reviewing this article, you determine that, in your case, a medicine or food may be the cause of the change in the color of urine, and after the consumption of this product, the color of the urine will return to normal, no additional examination is necessary.

Cases in which the appearance of blood in the urine does not require an examination to look for a tumor

In many situations, the appearance of blood in the urine is associated with injury or inflammation of the urinary tract. In these cases, it should be assumed that the cause of the bleeding is known and therefore there is no need for a follow-up examination to identify the hidden focus of cancer.

The presence of blood (including erythrocytes) in the urine should be considered an explicable phenomenon:

1. In the presence of pronounced signs of urinary tract infection: severe (cutting) pain in the lower abdomen + frequent and strong urge to urinate. In this case, traces of blood in the urine should disappear along with other symptoms of infection (see. cystitis treatment). With infections and injuries of the urinary tract, blood can be released in the form of clots.
2. While wearing a catheter in the urethra, as well as immediately or during the first day after removal of the catheter.
3. Within hours or days after cystoscopy (see cystoscopy: information for patients).
4. Within a few hours after a prostate biopsy (see Prostate cancer, diagnosis and treatment. PSA blood test. Biopsy of the prostate).
5. Within a few days after prostate surgery for adenoma (see. treatment of prostate adenoma).
6. Within a few days after the procedure for crushing stones or removing stones by percutaneous nephrolithotomy or ureterorenoscopy (see. removal of kidney stones)
7. During an attack of renal colic (migration of a stone from the kidney). Other symptoms of renal colic may include severe pain in the back or abdomen (see below). what to do in case of renal colic).
8. 1-3 months after bachytherapy or external radiation for the treatment of cancer of one of the pelvic organs (prostate, uterus). In such situations, the presence of blood in the urine can last up to 6-8 months. If traces of blood appear in the urine several years after brachytherapy or external radiation, you should immediately consult a doctor. It is well known that brachytherapy and external irradiation of the pelvic region increase the risk of developing bladder cancer.

Normally, urine sediment should contain less than 2-3 RBCs per field of view. An increase in the number of red blood cells in the urine ...

Normally, the urine of a healthy person is a clear liquid, without impurities and suspensions. A change in color, smell, or other reaction indicates the development of pathology. A serious symptom is urine with blood. In medical terminology, this phenomenon is called hematuria, which is one of the symptoms of diseases of the genitourinary system. Without knowing what causes bloody impurities in the urine, it is quite difficult to establish a diagnosis and choose the right treatment aimed at eliminating the original disease.

Urine, or urine, a person is a type of excrement that is formed as a result of life. As a result of blood filtration in the kidneys, reabsorption and secretion, urine is formed in the kidneys. The composition of urine in people is not the same and depends on age, degree of activity, weight, gender, etc. Blood in the urine indicates a violation of the normal functioning of some systems of the human body. The causes of pathology are surgical or therapeutic in nature.

Hematuria is a kind of reaction of the human body to malfunctions. Given the amount of blood in urine, two types of pathology are distinguished:

1. Macrohematuria.
2. Microhematuria.

Visually, you can determine: if the blood in the urine is present in such an amount that its color changes to pink or red, and the number of red blood cells increases significantly, then we are talking about macroscopic hematuria. In the second type of pathology, urine does not change its usual color, but increased amount erythrocytes is determined when performing appropriate laboratory tests.

Macrohematuria is classified into subspecies, including:

• initial, or initial, hematuria is a pathology of a surgical nature, in which blood clots in the urine appear due to bleeding from the urethra as a specific reaction in tumors and injuries of the urethra;
• final, or terminal, hematuria - a surgical pathology with a source of bleeding in the urethra or bladder, the causes of which lie in the formation of ulcers, stones or tumors in the bladder;
• complete, or total, hematuria is a pathology of a surgical or therapeutic nature with a source of bleeding (sometimes profuse) in the kidneys, the causes of which lie in urolithiasis or in inflammatory processes of the parenchyma and urinary tract.

Causes of blood in the urine

The presence of blood in the urine can have various causes, of which there are about 200 in practice. However, hematuria is more common in the following diseases:

1. The development of inflammatory processes and infectious diseases of the genital organs and urinary tract.
2. Oncological diseases.
3. Urolithiasis disease.
4. Injuries of the urinary system.
5. Glomerulonephritis and other kidney diseases including pyelonephritis, polycystic disease, amyloidosis, hemorrhagic cystitis, etc.
6. Blood diseases.
7. Diseases of the prostate.
8. Pathological conditions of the vessels of the kidneys, other causes.

Treatment of pathology is aimed at eliminating the cause that provoked it. Positive dynamics of treatment is possible with the correct diagnosis.

The presence of blood in the urine at the beginning of urination means a possible lesion of the prostate gland, urethra. At the end of urination, the appearance of blood may indicate that the problems are in the neck of the bladder, in the upper part of the urethra, in the prostate. By the presence of blood in the middle portion of urine or at any stage of urination, pathological processes in the bladder, kidneys or ureters can be judged.

Macro- and microhematuria may be the result of increased blood pressure, bleeding disorders, hereditary diseases of hemophilia and Alport syndrome, staphylococcal infections, etc. Blood in the urine with pathologies of the urinary tract can complement pain at the beginning or end of urination, in the lower back or lower part abdomen, and have a character of different intensity.

You can also note some of the natural conditions of a person in which blood appears when urinating. This phenomenon can manifest itself as a reaction to the use of a catheter, during physical exertion, when the walls of an empty bladder rub against each other, as a result of menstrual blood entering the urine sample.

In some situations, urine may acquire a faint pink color after eating beets or other natural food colors, after using certain pharmacological drugs.

What are the symptoms of bloody urine?

Urination with blood accompanies such a symptom as pain. Painful sensations are weak or intense. Pain may be present at the beginning, at the end of urination, or during intercourse. Pain during urination with an admixture of blood indicates the development of an inflammatory process in the bladder, the formation of stones, urethritis. Moderate pain may be accompanied by microhematuria.

In kidney diseases, the presence of blood in the urine in patients is supplemented by symptoms such as pain in the lumbar region, in the lower abdomen, the intense nature of which is caused by physical activity. If there is no pain, then blood in the urine may be a symptom of an oncological disease of the urinary tract, kidneys.

Features of hematuria in men, women and children

Hematuria indicates malfunctions in the body, but the reaction to pathology can be expressed in different ways and be accompanied by different symptoms in men, women and children. In addition, depending on gender, blood in the urine may indicate various diseases and have different causes. Treatment is prescribed taking into account the individual characteristics of the patient's health and the course of the disease.

Among the male part of patients who have hematuria, the pain increases after physical activity. This is physiological hematuria, its provocateur is an increase in blood pressure, after which there is an increase in renal blood flow. Treatment in this situation is not required, enough rest and limitation of stress, after which the pathology goes away on its own.

In men, blood appears in the urine with prostatitis or with cancer. In diseases of the prostate, pain is most often present at the end of urination. Malignant tumors are diagnosed in 19% of patients. When they grow, the walls of blood vessels are destroyed and bleeding occurs. Treatment is required immediately.

In women, blood after urination often appears as a result of cystitis, an inflammatory disease of the bladder. With hemorrhagic cystitis - externally, urine looks from slightly colored to the color of meat slops. Pain is present during the act of urination, the urge to urinate becomes more frequent. Treatment ends with a positive result with timely diagnosis, the prognosis is favorable.

Among pregnant women, there is such a phenomenon as idiopathic hematuria, which is not a symptom of the disease, but occurs by itself. Such a reaction of the body can be caused by a change in the hormonal background, a mechanical effect on the urinary tract and kidneys from the fetus, intrauterine pressure.

To rule out serious health problems, a pregnant woman is required to undergo a thorough examination. If necessary, treatment compatible with the gestation period can be prescribed.

Many people wonder why there may be blood in the urine in children. Paying attention to such symptoms in a child is imperative. IN childhood early signs of some diseases of the urinary tract and kidneys appear, and the body's response to them is formed. Treatment of a child's body is easy, positive dynamics comes quickly.

Diagnosis of hematuria

At home, special test strips are used to test urine. If no blood is found in the urine as a result of independent study which means you don't need to see a doctor. However, in cases where the reaction of the body and symptoms increase, the advice of a competent specialist and professional treatment will help to avoid serious health consequences.

In a medical institution, the patient is treated only after a thorough examination, including:

• laboratory analysis of urine, analysis according to Nechiporenko, analysis of daily urine, microscopy of urine sediments;
• ultrasound scanning of the pelvic organs and kidneys;
• excretory urography;
• kidney biopsy;
• cystoscopy with biopsy;
• retrograde renography;
• radiography;
• computed tomography.

Health should be taken seriously. Changes in the color of urine should be regarded as a reason to consult a doctor. When diagnosing, it is determined whether pathological changes occur in the patient's body, whether he needs treatment and what kind. This is the only way to avoid serious problems, maintain health and quality of life.

In the presence of red blood cells in urine, hematuria is diagnosed. Blood in the urine of a child, pink blotches on a diaper cause serious concern to parents.

Not always the appearance of red blood cells in the urine can be seen visually. At a low concentration, microhematuria is diagnosed only according to the results of laboratory tests. In the presence of blood cells, additional tests are required to find out the reasons for such changes in the child's body.

Blood in the urine does not always indicate the presence of diseases. The reason may be a physiological process, for example, heavy loads during sports.

When is blood in urine considered normal?

After the birth of a child, the body is restructured and adapted to new conditions. In this case, the erythrocytes accumulated during prenatal development are destroyed and others are formed. With this process, the appearance of red blood cells in the amount of up to 7 cells per field of view is possible. How long this process will last depends on the immunity of the child.

Given the underdevelopment of the paired organ in children under two years of age, the appearance of red bodies in the urine is possible due to insufficient filtration. In this case, the presence of erythrocytes up to 5 cells in the field of view is the norm.

In children older than two years, if there is no history of diseases of the urinary system, the content of erythrocytes in urine should be as follows:

• for boys up to 1;
• for girls up to 3.

An increased concentration indicates a deviation from the norm.

The appearance of blood in the urine of a child is considered safe in such cases:

• after using a catheter in the urethra, spotting is possible after 2-3 days;
• when the child experienced heavy physical exertion before the test;
• when using an endoscope to diagnose a disease, there may be blood blotches in the urine for two days;
• after removal or crushing of stones.

Causes

In the absence of pathologies, hematuria in children develops as a result of the inability of the body to environmental factors and stress. Often, children with blood in the urine need restorative therapy.

Reasons for the development of hematuria:

• prolonged exposure to the sun during the hot season;
• visiting the bath;
• the use of spicy foods and spices;
• excessive intake of citrus fruits and chocolate;
• transferred stresses;
• the body's response to medication.

In newborns

If a change in the color of urine occurred in an infant in the first days of life, do not panic. Most likely, this is a physiological process - uric acid infarction, which, despite the seriousness of the name, is not a disease and does not require treatment.

But the presence of blood in the urine of a newborn may be the result of infection of the tract, developmental anomalies, trauma during delivery. Therefore, the formation of blood in the urine of a baby requires testing and additional examination.

At the baby

The development of hematuria in children under one year is most often the result of vascular fragility. It can occur with a severe cold, as a result of an exorbitant load for the baby. Blood in the urine may appear if hygiene is not observed, which contributes to the development of infectious processes. Perhaps the appearance of red blood cells in the urine and in the presence of congenital pathologies in the child.

Teenagers

In older children, diseases of the urinary system of an inflammatory nature become the cause of the development of hematuria. In this case, along with the blood, mucus and pus may be discharged. The formation of blood impurities may be a consequence of the ICD, the calculus goes through the urinary ducts, damaging them.

Cause classification

The provoking factors for the appearance of blood in the urine are divided as follows:

1. Prerenal - intoxication, sepsis, infections.
2. Renal - diseases that affect the kidneys.
3. Postrenal - pathologies of the lower organs of the urinary system.

Erroneous analyzes

It is very important to properly collect urine for research. If you do not observe hygiene before donating body fluid, the result may be false. In the presence of an inflammatory process in the intestine, the contained erythrocytes fall into a container for collecting urine.

Girls should not give urine before the start of menstruation and a week after the end. Blood cells can appear with hormonal disorders, as well as with pathologies of the appendages.

Hematuria in pathologies

Traces of blood in the urine of a child can be the result of injury. With a fall, blows to the abdomen, bruises of the lower back, with sports injuries, blood flow in the parenchyma is disturbed, which leads to gross hematuria. With rupture of the kidneys and ureters, there is profuse internal bleeding, requiring immediate hospitalization.

Hematuria in children most often develops as a result of violations of the urinary organs:

1. Inflammatory. Diseases of the pelvis, parenchyma, cystitis and urethritis.
2. Non-inflammatory. ICD, oncology, developmental anomalies, hydronephrosis.

In children, blood in the urine may be due to diseases:

• infectious (flu, meningitis, scarlet fever, typhoid);
• formations of suppuration with phlegmon;
• pneumonia and sepsis;
• congenital pathologies associated with impaired hematopoietic function, modification of blood cells, insufficient coagulability, hemophilia;
• heart defects.

Symptoms of hematuria

In addition to staining urine during pathological processes in the organs of the urinary system, other signs may also appear.

With glomerulonephritis, there is a sharp decrease in the volume of excreted urine, and the following symptoms are also present:

• malaise;
• headache;
• increase in body temperature;
• the presence of mucus and impurities in the urine;
• puffiness of the face.

With pyelonephritis, the following manifestations are present:

• lower back pain;
• temperature fluctuations accompanied by chills;
• the presence of mucus and pus in the urine;
• cramps during deurination;
• sudden urinary incontinence;
• frequent urge to empty the bladder.

Cystitis most often occurs in girls, characterized by the following symptoms:

• when emptying the bladder, constant pain;
• discharge of urine with mucus and pus;
• malaise;
• discomfort in the pubic area;
• incontinence.

KSD is quite rare in children. At this age, there is more often a violation of metabolic processes, which leads to a high salt content, which in the future can provoke the formation of stones.

Diagnostics

When red blood cells appear in the urine in children, first of all, you need to take a blood test. Regarding additional methods that may need to be paid, the attending physician will inform. The following studies may be needed:

• blood test (general, clinical, according to the method of Nechiporenko and Ambourzhe);
• establishment of an indicator of coagulability;
• tests regarding the content of nitrogenous substances;
• ultrasonography genitourinary system and abdominal organs;
• excretory uropyelography.

Type of erythrocytes

Not only the quantitative level allows you to establish the degree of development of hematuria, the type of red blood cells indicates the cause of the appearance of blood in the urine.

In the presence of erythrocytes of a standard structure, the presence of inflammation of the lower organs of the urinary system is possible. If it goes, this indicates damage to the neck of the urethra, the development of a tumor in it, in boys - inflammation of the urethral canal.

With the modification of red blood cells, diseases of a congestive nature are possible, which is often found in the development of KSD. This occurs as a result of urinary retention when the urinary tract is blocked by a calculus, while the bodies change shape and are converted into rings.

To determine the cause of hematuria in children, an examination by a gynecologist and urologist is required.

Treatment

Therapy of hematuria is carried out after diagnosis and depends on the type of disease:

• in case of injury, surgical intervention may be required;
• if glomerulonephritis is established, a special diet and medication (hormonal and cytostatics) are required;
• in the presence of cystitis or pyelonephritis, antibiotics are used for treatment;
• if tuberculosis is the cause of hematuria, hospitalization is required in a specialized dispensary.

Oncological diseases in children are rare, more often such processes are diagnosed in older people. Hemostatic agents are used as symptomatic therapy.

With the timely detection of pathologies and complex treatment, you can get rid of the disease and such a manifestation as blood in the urine.

In professional language it is called hematuria. If blood is present in the urine, its color changes due to the presence of red blood cells in the blood.
Depending on the amount of blood, hematuria is divided into macrohematuria and microhematuria. In the first case, there is so much blood that it can be seen with the naked eye. In the second case, the amount of blood is scanty and it is detected only during a laboratory test or with the help of special disposable tests - strips.
Symptoms of hematuria may be painful or painless. And by origin glomerular or postglomerular.
In any case, the presence of blood in a urine sample is not normal.

The number means nothing

Any amount of blood in the urine can indicate a very serious illness. Therefore, even if microscopic blood impurities are detected, a complete examination of the body is necessary. Moreover, the older the person, the more likely the presence of serious diseases.

Causes of blood in the urine

Blood can enter urine from organs in the path of urine, i.e. from the kidneys, ureters, bladder, or urethra. There are more than one and a half hundred different reasons for this phenomenon.

The most common causes of hematuria are:

• Infectious diseases,
• neoplasms,
• Conglomerates.

Less common causes of blood in the urine:
1. Congenital anomalies: cysts or polycystic kidney disease.
2. Diseases in which blood clotting worsens: leukemia, hemophilia, sickle cell anemia, as well as taking drugs that worsen blood clotting.
3. Vascular diseases: thrombosis of the vein of the kidneys, the presence of a blood clot in the renal vessels.
4. Other kidney diseases:

• Pyelonephritis. With this disease, the patient may not experience pain, but this is rare. Usually the first signs of pyelonephritis are chills, pain in the lower back,
• Glomerulonephritis. With glomerulonephritis, a microscopic amount of blood is released, which can only be detected in the laboratory. The disease can pass completely without any signs, symptoms of kidney failure may be observed,
• papillary necrosis. This disease is typical for patients with diabetes mellitus, with impaired oxygenation. The disease is treatable.

infections

This is primarily tuberculosis of the kidneys or bladder, as well as purulent processes provoked by pyogenic microorganisms, cystitis, urethritis.

After injury

Blood in the urine after an injury can be observed when a kidney ruptures. Trauma can be either blunt or penetrating.
The bladder can also be injured. For example, when running for a long time with an empty bladder, its walls can rub against each other. After such a run in the urine, there may well be a slight presence of blood.
Such a patient should be examined immediately. Already during his examination and questioning, the doctor may suspect the source of blood discharge. In the event that the bruise of the abdomen or pelvic region was very strong, and also if there was never urination after the injury, the doctor may suspect a rupture of the urinary organs.
If the perineum has been damaged in the "sitting on a horse" position, there is a possibility of injury to the urethral bulb.
If it hurts above the pubis, and the pain spreads throughout the abdomen, if the patient is sick, a bladder rupture can be suspected.
If the upper abdomen hurts, there is a possibility of severe kidney injury.

For kidney or bladder stones

The most common cause of blood in the urine is urolithiasis. In the papillae of the kidneys, salt crystals collect, which later “attract” all new deposits to themselves.
Most often, the patient is unaware of the presence of kidney stones, but with laboratory research blood can be found. Stones create favorable conditions for the development of infection, and also irritate the mucous membrane of the kidneys and ureters. Only very large stones block the ureters and cause sharp pains called colic.

Check for the presence or absence of stones in urinary tract possible with the help of excretory urography.

In urethral cancer, blood is observed not only in the analysis of urine, but it can also be found in the interval between urination at the outer end of the urethra.

If the blood clots are in the form of worms, this is highly likely to indicate kidney cancer.

Not only malignant neoplasms lead to the appearance of blood in the urine test. Benign tumors can also cause it. However, they are very rare in the urinary organs. Most often, these are kidney cysts.

Angiomyolipoma - This is a benign neoplasm, more often found in women during pregnancy. Its volumes can be very large, in which case it can be manifested by the presence of blood in the urine. The entire tissue of angiomyolipomas is permeated with blood vessels and fat cells. Vessels often spontaneously burst, and blood enters the urine. This type of tumor is treated only with the help of surgery. It is removed without damaging healthy tissues.

Among women

The most common cause of blood in the urine in women is inflammatory processes in the urinary system. With such processes, blood circulation changes, the infection leads to the fact that red blood cells penetrate into the tissues of the body.

Very often, the presence of hematuria is explained cystitis . During urination, a woman experiences acute pain, cramps or burning. The anatomical composition of the pelvic organs in women is such that favorable conditions are created for infection of the urinary organs. Due to the short urethra, it is easy for infections to enter the bladder.
If hematuria is observed during menstruation, this indicates the presence of bladder endometriosis.

Pregnant women often have blood in their urine. But so far, no doctor can really explain what is the reason for this phenomenon. One explanation says that during the development of the fetus, the uterus increases in size, compresses nearby urinary organs and causes microscopic injuries. They are absolutely harmless to the health of both mother and fetus. However, if blood is found in the urine during pregnancy, it is necessary to visit a doctor as soon as possible.

The causes of blood in the urine in women can be both diseases characteristic of both sexes, for example, urolithiasis, cyst, pyelonephritis, small cell anemia, kidney cancer, and completely physiological causes. For example, during the collection of a urine test, menstrual blood got into it.
Sometimes when taking hormonal birth control pills some blood is found in the urine. This is due to the fact that hormones, which are in tablets, violate the condition of the walls of blood vessels in the urinary organs. The trophism of tissues worsens, inflammations develop, which are sometimes impossible to detect visually.

In men

The reason for the presence of blood in the urine of the stronger sex may be a disease of the prostate gland, which is usually not malignant.

With prostate adenoma or benign hyperplasia, there is a low probability of blood appearing in the urine. But more often it happens with a combination of adenoma and cystitis in an acute form.

The disease is diagnosed by determining the level of urine outflow and the amount of residual urine in the bladder. Treatment is carried out promptly.
Very often in men, blood in a urine sample is detected after heavy physical exertion. Blood pressure increases, the movement of blood in the kidneys is activated, and under the influence of certain substances that remain in the body during heavy exertion, a small amount of blood enters the urine. Good vacation- and there will be no more disturbing phenomena.

Prostate cancer
About 20% of patients who come to the clinic with obvious signs of blood in the urine are sick with this particular disease. If the amount of blood is so small that it is detected only by chance during the analysis, the probability of prostate cancer is 5%. This disease is detected using an ultrasound-guided biopsy. The method of therapy is chosen depending on the degree of the disease. Sometimes removal of the prostate and subsequent radiation is prescribed. If the disease is at the terminal stage of development, hormonal treatment is also added.
Inflammation of the prostate - prostatitis. The presence of blood in the urine is not the most common symptom of this disease. However, in some cases they are related.

The child has

Half of the children who are examined for hematuria have glomerulonephritis.

Other reasons:

• hereditary predisposition to kidney disease,
• Infection,
• Illiterate care of the reproductive organs after birth,
• Injury to the urethra, inflicted by the child himself during the game.

The blood vessels of a baby are thinner and more fragile than those of an adult. Therefore, some diseases can contribute to the penetration of blood into the urine. It may be hemorrhagic diathesis or another disease. Sometimes blood can get into the urine when treated with some strong drugs.

The most common cause of blood in the urine of a child is inflammatory processes in the kidneys or bladder. Girls are more prone to such diseases, since their urethra is shorter and the path for infection is less. With inflammation, the child will definitely complain of pain, often urinate, cry during urination.
Sometimes parents panic at the sight of a change in the color of the child's urine. But sometimes red does not mean the presence of blood. It may appear with the use of certain products. If the child did not eat anything bright red, you should definitely and immediately visit a doctor.

During pregnancy

Blood can be detected during pregnancy at any gestation period. At the same time, such a symptom is always very unnerving for both the woman herself and her doctors. Although in the vast majority of cases this phenomenon is causeless ( idiopathic) and does not cause any trouble, a woman must be carefully examined.

Doctors believe that the presence of blood in the urine during pregnancy can be associated with a change in the hormonal background, as well as squeezing the urinary organs by the uterus.
Usually, immediately after the birth of a child, all disturbing symptoms disappear, and only sometimes hematuria does not go away. But in this case, it is a symptom of a disease of the bladder, urethra or kidneys.

In the elderly

If hematuria is found in an elderly member of the stronger sex, it may indicate the likelihood of a microbial process that develops when the bladder function is impaired and urine outflow worsens. This is likely with a malignant neoplasm of the prostate, urethral stricture, as well as benign prostatic hyperplasia. Therefore, it is important to identify the presence of signs of changes in urination: incomplete emptying of the bladder, weakness of the jet, difficulty with urination.

If in an elderly person hematuria is combined with pain in the iliac bones, this may indicate an embolism of the renal arteries. In such a patient, it is important to identify vascular and heart diseases, as well as to find out if he is taking medications for such diseases.

The appearance of hematuria after sex is a sign of cystitis

If blood in the urine is associated with pain and appears after intercourse, the patient probably has postcoital cystitis. It develops against the background of inflammation caused by pathogenic microflora penetrating the urinary organs during copulation. Next, the microorganisms rise up to the bladder.

The structure of the urinary organs in women contributes to the development of postcoital cystitis. When the urethra is located in such a way that seminal fluid and vaginal mucus penetrate into it during copulation, infection of the genitourinary system and the development of inflammation in the urethra and bladder are likely. The position in which copulation is carried out is very important. Since the vagina, urethra and anus are in close proximity to each other, the likelihood of infection increases.
Signs of postcoital cystitis can manifest themselves both from the first sexual experiences and at a later age.

Diagnosis is carried out by a urologist on the basis of examination and laboratory tests.
Treatment of the disease is medical, in some cases, if it is ineffective, an operation is prescribed.
To prevent the development of postcoital cystitis, hygiene requirements should be observed, barrier contraceptives should be used, and the penetration of semen and vaginal secretions into the urethra should be avoided.

It's not always blood

Often the color of urine is affected by food. So, eating red beet gives the urine an intense reddish tint. Some dyes added to food also stain urine.
A number of medications can change the color of urine. For example, when treated for tuberculosis with rifampicin, the urine may become orange in color, some patients believe that this is due to the presence of blood.

How to detect hematuria?

There are three methods for detecting blood in urine:

• Organoleptic ( by eye),
• With the help of a rapid test,
• With a microscope.

The first two methods are quite approximate. So, when examining urine, any red dye can be mistaken for blood. A test can give a false positive result in the presence of hemoglobin in the urine.
The mechanism of action of test strips for blood in the urine is based on the reaction with hemoglobin of red blood cells. The tests are very sensitive. However, their results should be cross-checked with laboratory tests.
These tests are more likely to produce false positives than false negatives.

How to find the cause of hematuria?

There are many diagnostic methods for this:

• patient questioning,
• examining it,
• General urinalysis,
• bacterial urinalysis,
• urine cytology,
• Urography intravenous,
• Ultrasound.

IN in large numbers cases, only examination and questioning of the patient is sufficient. So, by the stage at which urination blood appears, it is already possible to suspect the cause of the violation.
If blood is found in the first portion of urine, then the urethra is affected.
If blood appears in the last portions of urine and is combined with pain, this indicates bladder stones, cystitis. In urolithiasis, blood is shed if the walls of the bladder contract around the stone during urine output.
Sometimes all portions of urine contain blood. And in this case, it is more difficult to establish the source of blood.

If the presence of blood in the urine is combined with pain in the lower back or abdomen, there is a possibility of infectious inflammation, neoplasm or kidney stones. Cystitis often occurs with fairly heavy bleeding. In this disease, during the excretion of urine, the patient suffers from burning or pain.
The presence of blood in the form of clots in middle-aged patients with a high degree of probability indicates the presence of a malignant tumor of the bladder. In the representatives of the stronger sex, difficulties with urination, for example, a sluggish stream, inhibition of urination and prolonged urination, indicate a violation of prostate function.

During the examination, women should definitely undergo a consultation with a gynecologist, and men with a rectal examination. Sometimes this makes it possible to immediately identify the neoplasm.
In order to clarify the presence of blood in the urine and the reasons for it, you need to pass an analysis, including the bacterial flora.
If the patient has already had a cancer, they will be given a cytology showing the composition of the cells present in the urine.

Visual inspection of the urinary system

This examination is mandatory in the presence of blood in the urine, even with its smallest amount. Usually, ultrasound or urography is used to examine the upper urinary system. For urography, an iodine-based contrast agent is injected intravenously. The device captures the movement of a contrast agent through the urinary system. As a result, the doctor receives several x-rays showing different parts of the urinary system. This is the most widely used method for diagnosing the condition of the excretory organs, which helps to detect stones and neoplasms in the upper parts of the urinary system.

Instead of urography, ultrasound is sometimes used along with a plain radiograph. The great convenience of ultrasound is that this type of examination is completely harmless.
If small tumors of the kidney parenchyma are the cause of blood in the urine, then ultrasound will detect them sooner than urography. But if the neoplasm appeared in the drainage system of the kidneys, urography is more effective. The benefit of any of these measures directly depends on the qualifications of the doctor. But in any case, urography and ultrasound are complementary methods. Sometimes both tests are ordered.
If these examinations indicate the presence of a neoplasm, computed tomography is selected as an additional method. As the first method of examination, CT is never used for such symptoms.
But, neither ultrasound nor urography will detect a neoplasm in the bladder. For this, cystoscopy is used. With hematuria, this examination is mandatory.

What to do?

Most people will experience great anxiety when they find blood in their urine. And rightly so. In no case should you try to independently diagnose and treat. Need to book a consultation as soon as possible. urologist.
Usually prescribed in such cases, an ultrasound examination of the urinary organs, a general blood and urine test, blood sugar levels, blood creatinine levels.
Since it is important to understand from which part of the urinary system blood enters for making a diagnosis, the doctor will interview the patient in detail and examine him.

After determining the cause, the appropriate treatment will be prescribed:

• For injuries, this is drug therapy and, often, surgery,
• With a neoplasm in the kidneys, an operation is prescribed,
• With an autoimmune disease or infection, drug therapy is used,
• In urolithiasis, ultrasound crushing or surgery is used,
• For ailments of the bladder, such as a neoplasm or a polyp, surgical treatment is used,
• If the bladder is infected, antibiotic therapy is prescribed,
• If the urethra is infected, antibiotic therapy is prescribed,
• In diseases of the prostate, antibiotic therapy is also prescribed, and in the future, surgical treatment is usually resorted to.

Before use, you should consult with a specialist.

Blood in the urine is medically called hematuria. It happens that it is detected only by microscopy of the sediment by an increased number of erythrocytes. A much more serious situation should be taken when bright blood comes out with urine, traces of clots or veins remain on the toilet.

These symptoms are referred to as microhematuria and macrohematuria, respectively. Normally, several erythrocytes are allowed in the field of view with microscopy of the urine sediment. There are also physiological causes the appearance of blood in the urine.

To exclude the influence of pathological changes, a study is being carried out not only to detect erythrocytes, but also to clarify the question of which part of the urinary system they belong to. This helps to establish a specific disease, the nature of the lesion.

Pathways for blood to enter urine

Blood and urine (urine) are the natural body fluids. They perform important functions and do not have the ability to mix. The barriers are:

• walls of vessels of different caliber;
• nephron membrane in the renal glomeruli;
• capsule of the kidney and the muscular layer of the ureters and bladder.

To decide why blood cells appeared in the urine, it is necessary to check the state of the protective mechanisms. There are 5 types of violations:

1. Destruction of the membrane that provides filtration and retention of erythrocytes in the renal glomeruli (nephrons) during the formation of primary urine. Such a process actively occurs in all types of inflammation of the parenchyma (nephritis), passes from the calyces and pelvis during the severe stage of pyelonephritis.
2. Loss of elasticity by the vascular wall, increase in its permeability. Feeding arteries and the venous network accompany all urinary organs, they deliver the material necessary for the cells to work, and waste waste products are carried away. Involvement of the vessel in inflammation leads to tissue loosening and increased permeability. Even more pronounced destruction can be with growing neoplasms, injuries.
3. General congestion in decompensation of cardiac activity necessarily affects the veins of the pelvic organs and kidneys. Phlebitis, thrombosis increase the pressure inside the veins and contribute to the release of blood into the urine.
4. Perhaps mechanical compression of the urinary organs and blood vessels, for example, a growing tumor, an enlarged pelvis with hydronephrosis.
5. Systemic capillary lesions in hemorrhagic diathesis, fevers, blood diseases cause local destruction of glomerular filtration mechanisms, increase permeability.

What does blood in the urine mean, you have to find out in each case individually.

Reliable data can be considered only obtained by the study of correctly collected urine.

Causes of microhematuria, independent of pathology

An increase in the number of erythrocytes in the sediment is possible after urine collection against the background of:

• overheating in a steam bath;
• prolonged exposure to the sun in the heat;
• transferred stress;
• drinking alcohol, overeating spicy and salty foods.

Blood in the urine after exercise in the form of microhematuria occurs temporarily and stops after rest. If the color of urine remains bloody for a long period, then this already indicates a possible pathology.

In the diagnosis, the disappearance of hematuria in the supine position and the resumption in the vertical position of the body matter. Such a distinguishing feature indicates the omission of the kidney (nephroptosis) and its pathological mobility.

The importance of getting blood into the urine with spotting in women from the genitals should be especially emphasized:

• during menstruation;
• from the eroded surface of the cervix;
• with fibromatous changes with uterine bleeding;
• in the postpartum period.

In men, blood in the urine test is often associated with prostatitis, prostate adenoma.

When do false suspicions of hematuria occur?

Some patients are afraid of the reddish tint of urine. They take it for obligatory blood impurities. However, this feature must be distinguished from the effect of food coloring on the color of urine.

The brightest color is obtained after eating beets, carrots, blueberries

The influence of drugs such as vitamin B 12, ascorbic acid, Analgin has been proven.

Deciphering the analysis, comparing the number of red blood cells with other elements of the urine sediment (leukocytes, protein, cylinders, bacteria, mucus, salts) makes it possible to find out the specific causes of blood in the urine.

What pathological changes cause hematuria?

Pathology includes the proven presence of blood in the urine. It is impossible to make a correct diagnosis based on one symptom. Taking an anamnesis, checking other clinical signs, the results of the examination help to find out the true causes and prescribe the optimal treatment.

Of the diseases of the urinary organs, hematuria is possible with:

• acute and chronic form of glomerulonephritis;
• severe form of cystitis;
• urolithic pathology;
• hydronephrosis;
• kidney tuberculosis;
• tumors of the kidney and bladder.

Less commonly, a symptom is observed with urethritis, pyelonephritis.

In this case, when the blood breaks, it spreads more to the perirenal tissue, it is not in the pelvis, which means there will be no hematuria

Traumatic injuries of the pelvis and abdomen:

• blows;
• bruises;
• gap;
• compression.

They are accompanied by microhematuria to severe bleeding during urination due to rupture. In medical institutions of a surgical profile, the consequences of installing a catheter in the urethral canal are considered an injury, while blood in the urine appears as a result of a violation of the integrity of the mucous membrane and small vessels.

The procedure leads to similar consequences.

Blood in the urine after surgery requires clarification by the attending physician of the degree of influence of volume surgical intervention to the urinary organs.

1. When removing a kidney or partial resection, a temporary thin tube is left in the cavity of the pelvis, through which urine and blood flow out. Through it, the diseased kidney is washed, and drugs are administered.
2. If the operation was not performed on the urinary organs, then the blood in the urine means the appearance of complications for the patient.

An injury to the perineum and bulb of the urethra followed by hematuria is considered to be an occupational injury for equestrians.

Poisoning with toxic substances is accompanied by a block of renal filtration, the inability to urinate on their own, and the release of clotted blood from the urethra.

Feverish conditions in any disease, as well as infectious hemorrhagic lesions of the renal capillaries are observed:

• with toxic damage by the breakdown products of protein and bacteria;
• hemorrhagic capillarotoxicosis.

In cases of cardiac decompensation with heart defects, hypertension, myocardial infarction, the main role is played by venous congestion and increased pressure in the renal vein system.

Blood diseases with reduced coagulability (thrombocytopenia, hemophilia) are accompanied by impaired renal function and hematuria in the final stage, as well as the intake of fibrin, which forms blood clots in the urine.

Erythrocytes may appear in the patient's urine when trying to treat him with sulfa drugs, hexamine, high doses of vitamin C, an overdose of anticoagulants. These drugs have toxic effects on the kidneys in sensitive people. Patients should be advised to monitor their urine if such drugs are prescribed.

What are the symptoms associated with hematuria?

The most difficult to diagnose is asymptomatic gross hematuria. It occurs suddenly, the patient does not feel pain, but notices a clear admixture of blood in the urine. In such cases, a tumor of the kidney or bladder is suspected. This disease, unfortunately, is latent for a long time.

When contacting a doctor, you need to quickly do not only a blood and urine test, but also conduct all kinds of examinations. The health and life of the patient depends on the timely start of treatment. If the patient complains that it is “painful to write” to him, and blood clots are found in the urine, then there is a suspicion of damage to the bladder as a source of bleeding.

Clots can form when there is inflammation (cystitis) with ulceration of the cervical area, a large stone, or a tumor.

Sometimes the clots look like "worms". They form in the ureters or pelvis. Blood comes from the parenchyma of the kidney. Often such bleeding is preceded by an attack of renal colic due to the movement of a stone in the pelvis or ureter.

You cannot decipher the analysis data yourself. The doctor in the diagnosis takes into account such manifestations as:

• pain when urinating;
• frequent urges;
• urinary retention;
• pain in the lower back and abdomen;
• nighttime urination;
• increase in body temperature;
• hypertension.

These symptoms confirm the opinion about the pathology of the urinary organs or deny it.

Read more about the symptoms of blood in the urine in children.

What conditions should be distinguished from true hematuria?

In differential diagnosis, urologists are faced with the need to distinguish true hematuria from similar conditions. These include:

• urethrorrhagia - the so-called outflow of blood in drops from the urethral opening spontaneously without the act of urination, occurs as a complication of the procedure of cystoscopy, catheterization of the bladder, bougienage;
• myoglobinuria is one of the manifestations of the syndrome of prolonged crushing, muscle myoglobin increases in the blood with massive destruction of muscle tissue, causes blockage of renal filtration, therefore red urine is found in victims of building blockages, terrorist attacks, such patients need urgent hemodialysis.

With the destruction of erythrocytes (hemolyzing effect of toxic substances, hemolytic crises), hemoglobin enters the blood, while the erythrocytes themselves are not in the urine sediment. The color of the urine becomes very dark. Seen in the background:

• shock from transfusion of incompatible blood group and Rh;
• burns 3-4 degrees;
• hemolytic anemia;
• severe stage of typhoid, diphtheria, scarlet fever.

Can diagnostics be carried out using express methods?
You can understand the state of a person who sees his blood in the urine. Waiting for test results is hard to bear. There are proposed methods for express analysis using special test strips. The instructions require that the strip be immersed in a container of urine, then dried and compared to a standard color scale, assessed for the presence of hematuria.

In the practice of urologists, this test is not considered sensitive enough:

• cannot accurately detect microhematuria;
• does not distinguish between hematuria and hemoglobinuria.

Therefore, self-testing at home is not recommended. It is better to collect urine in accordance with the rules and get a fairly informative conclusion.

What determines the type of erythrocytes?

One detection is not enough to answer the question about the source of bleeding, the level of damage to the urinary tract. To do this, the laboratory assistant must determine the type of change in erythrocyte cells.

By microscopy of urine sediment, 2 types of red blood cells are detected:

1. Unchanged - look like rounded cells with a concave inward middle, saturated with hemoglobin, have a reddish tint (similar cells are present in the blood). They come from the kidneys or bladder in the absence of any urinary retention.
2. Altered or leached - formed in the case of a long stay in the urine, look wrinkled and ring-shaped, lose hemoglobin. Similar changes are possible with nephrolithiasis, a tumor that overlaps the ureter or neck of the bladder, anomalies of the ureters and kidneys, hydronephrosis.

Microscopy of urine sediment is carried out in the laboratory

The leached erythrocytes in the urine of people with a predominant meat type of diet are considered a variant of the norm. The restriction of vegetables and fruits leads to a lack of alkaline reserve in the body. To maintain the balance, alkalis are "extracted" from their own cells.

The detection of impurities in the urine, similar to blood, should alert the patient and lead to the realization of the need for a complete examination. It should be borne in mind that laboratory analysis is not considered by doctors as the main symptom of a particular disease.