What is Hematuria?
Seeing blood and blood cells in the urine visually or under a microscope is called “hematuria” or “bloody urine”. This can be visible (gross) or revealed in a urine test (microscopic). In both cases, it is important to determine the cause of the bleeding. Seeing blood in the urine is a worrying situation and in most cases, although the cause is harmless, blood in the urine (hematuria); It may be a symptom of a serious disease such as bladder cancer, kidney and prostate cancer, kidney and urinary tract stones.
When a small amount of blood is mixed into the urine, it can be seen in colors ranging from pink to dark red, depending on the amount of blood. Bleeding in the urine is usually painless, but pain may occur if there are blood clots in the urine, due to obstruction or if it is accompanied by infection. Even microscopic hematuria may occur without any symptoms, and it may persist for years without the patient realizing it. If blood is seen in the urine, which is a sign of many serious diseases, a doctor should be consulted. Some medications that relieve constipation and contain dyes such as azo, which dye the urine red, and some foods (beets, strawberries, raspberries, blackberries, etc.) can dye the urine red without blood in the urine. Again, blood may be seen in the urine after heavy exercises (especially in long-distance runners), but the urine returns to normal within a few days. Other risk factors of hematuria include age and some hereditary diseases.
Causes of Hematuria
In Urine When viewed through a microscope, the maximum number of blood cells (erythrocytes) normally seen is around 1-2 in men and 3-4 in women. Bleeding in the urine can originate from any area, from the kidneys to the urinary ducts (ureters), bladder, prostate and the urinary tract (urethra), where urine is expelled to the external environment. Kidney and urinary tract stones, infections and cancers are the most common serious causes of bleeding in the urine, and under the age of 40, urinary tract infections and stone disease are more common, and above the age of 40, hematuria can be a sign of urinary tract infections, prostate enlargement, prostate cancer, kidney and bladder cancer. .
1-Kidney and Urinary tract infections: In case of microbial infections of the kidneys and urinary tract (cystitis, pyelonephritis urethritis, etc.), there may be bleeding in the urine, but bleeding is usually accompanied by difficulty during urination, burning, painful and frequent need to urinate. Apart from these, complaints of urgent need to urinate and foul-smelling urine may be observed. If the infection is in the kidney, it may also be accompanied by fever and flank pain. In prostate infections, in addition to bleeding, urinary difficulty and the need to urinate frequently come to the fore.
2-Urinary tract stone disease:Kidney and urinary tract stones, which do not cause obstruction in the urinary tract, may only cause symptoms with bleeding in the urine. If there is obstruction, severe colic pain is accompanied by bleeding. If this is accompanied by an infection, the picture becomes more complex.
3- Prostate enlargement: In prostate enlargement, which is mostly seen in men over the age of 40, bleeding in the urine can be detected in addition to the main complaint of the patient. It may cause bleeding in the urine.
4-Kidney diseases: Hematuria may be observed in some medical diseases of the non-microbial and filtration units of the kidney, such as glomerulonephritis, which may cause kidney failure sufficient to lead to transplantation. It could be a symptom. Bleeding in the urine also occurs in diseases called nephritis, which occur in the filter system of the kidney. Blood in the urine may also be seen as an additional finding in some systemic diseases such as diabetes.
5-Urological Cancers: The most important and serious cause of visible or microscopic blood in the urine, with or without clots, may be urological cancers. One of the most important symptoms of prostate and other urological cancer, especially bladder and kidney cancer, is bleeding in the urine. In fact, classically, men who are over the age of 40, smoke, and have painless clotted bleeding in the urine are considered to have bladder cancer until proven otherwise. The common denominator accompanying bleeding is smoking. While bleeding in the urine is seen initially and continuously in the long term in bladder cancer, it is more common in advanced stages in prostate and kidney cancer.
6-Other reason Bleeding in the urine may occur in hereditary genetic diseases such as sickle cell anemia and Alport syndrome, in kidney and urinary tract trauma, and in some medications. Anticancer drugs such as cyclophosphamide, radiotherapy, blood thinners such as aspirin and antibiotics such as penicillin can cause serious bleeding in the urine.
DIAGNOSIS
1- History and physical examination is the first step in investigating hematuria.
2-Simple urine test: Even if there is visible bleeding, a simple urine test is required to determine whether there are additional findings. Again, urine collected in a transparent container should be examined visually. If there are signs and symptoms suggestive of infection, a urine culture is taken.
3-Basic routine blood analysis should be requested from the patient complaining of hematuria.
4-Imaging. Tests: Ultrasonographic imaging, which is easily accessible and feasible, is the basic examination method in patients with bleeding in the urine. In addition, computed tomography (CT) and magnetic resonance (MR) imaging may be requested when necessary
5-Cystoscopy:If no results can be obtained with other methods, cystoscopic (endoscopic) examination may be required. Cystoscopy is a diagnosis method that allows the examination of the bladder and urinary tract (urethra) using a light-camera endoscope called cystoscope, used for bladder cancer and some other clinical conditions (stone, tumor, prostate, etc.).
6- Sometimes the cause of bleeding in the urine cannot be found. In this case, he may recommend follow-up at regular intervals, especially if there are risk factors for bladder cancer such as smoking, exposure to environmental toxins, or a history of radiation therapy.
TREATMENT
In the urine Treatment of bleeding is possible by eliminating the main factor causing bleeding. Bleeding is not a disease but a symptom of an existing disease. When the disease causing bleeding is treated, hematuria is also treated.
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