HAEMATURIA

Haematuria means the appearance of blood in the urine. It can be divided into two categories:

1. Microscopic haematuria: red blood cells are only visible under a microscope.
2. Macroscopic haematuria: blood is visible in the urine, also known as 'gross or frank haematuria'. This is always abnormal except in menstruating women and needs to be investigated.

Occasionally "hemoglobinuria" is used synonymously, although more precisely, it refers only to hemoglobin in the urine.

Causes

There are many conditions that can cause haematuria, most of which are not life-threatening. However there are a number of serious causes of haematuria, such as cancers, that need to be detected.

1. Urinary tract infection: Haematuria can be caused by an infection in any part of the urinary tract, most commonly the bladder (cystitis) or the kidney (pyelonephritis).
2. Inflammation/infection of the prostate in men.
3. Stones (calculi):
   • in the kidney,
   • bladder or ureters.
4. Exercise: Exercise haematuria is a non-serious condition that athletes or joggers can get after intensive exercise.
5. Trauma: Traumatic injury to any part of the urinary tract from the kidneys to the urethral opening (the connection between the bladder and the outside world) can cause haematuria.
6. Drugs: Haematuria can be caused by medications, such as blood thinners, including heparin, warfarin or aspirin-type medications and cyclophosphamide (Cytoxan).
7. Glomerulonephritis: Glomerulonephritis refers to a group of kidney diseases that are characterized by inflammation of the glomeruli, the filtering units of the kidneys. Glomerulonephritis is a rare complication of certain viral and bacterial infections, but can also result from specific immune-system abnormalities, especially those involving immunoglobulin A (IgA), systemic lupus erythematosus (lupus or SLE) or diabetes. Sometimes there is no identifiable cause. 8) Bleeding disorders: including conditions that run in families such as haemophilia.
8. Cancers of the kidney, prostate or bladder.

Investigations

• Urinalysis: Firstly by dipstick testing in the surgery, then in the laboratory. Urine is analyzed in the laboratory under a microscope to look for protein, white cells and red cells to identify a kidney or bladder infection, or kidney inflammation (Glomerulonephritis).
• Urine culture: Urine is placed on culture plates to see if bacteria grow. This is used to confirm a urine infection that may be causing the haematuria.
• Cytology: used to detect cancer cells in the urine.
• Blood tests: to check for signs of urinary tract infection, kidney failure, anaemia (which often accompanies kidney problems), bleeding disorders, or abnormally high levels of blood chemicals that can encourage the formation of kidney stones.
• Radiology: a range of tests including intravenous pyelogram (the main test used), ultrasound of the urinary tract to look for abnormal masses such as stones, CT scanning.
• Cystoscopy or ureteroscopy- This test uses a camera at the end of a flexible tube to examine the bladder wall. It is possible to do this test under local anaesthetic.

Diagnosis

• Exclude transient causes, such as urinary tract infection, before further assessment
• A urine dipstick test for blood is generally sufficient. It is sensitive when performed on fresh voided urine with no preservatives. A score of <1+ is positive; a trace amount is considered negative
• A positive result for haemolysed red blood cells should be treated the same as for non-haemolysed red cells
• Further assessment is warranted in patients with urinary tract symptoms and non-visible haematuria and a score of <1+ on a single blood dipstick test
• In patients with asymptomatic non-visible haematuria confirm persistence of blood in at least two out of three dipstick tests
• It is not necessary to confirm the dipstick result by microscopy.

Management

1. First of all the causative factor has to be finding out and accordingly case should be treated.
2. In severe cases it should be immediately referred to the hospital.
3. Homeopathy- Homoeopathic medicines will help effectively in cases of haematuria unless major pathology is involved. The medicines will be selected based upon the symptoms the patient or the doctor observes.

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