1
Forth stage
Surgery
(Urology)
Lec-21
د.محمد فوزي
19/10/2015
Hematuria
DEFINITION : More than three red blood cells are found in centrifuged urine per high-
power field microscopy( > 3 RBC/HP). Normal urine: no red blood cell or less than three red
blood cell According to the amount of RBC in the urine, hematuria can be classified as:
microscopic hematuria: normal colour with eyes
gross hematuria: tea-colored, cola-colored, pink or even red
ETIOLOGY
1.Diseases of the urinary system
<< the most common cause Vascular
arteriovenous malformation
arterial emboli or thrombosis
arteriovenous fistular
utcracker syndrome
renal vein thrombosis
loin-pain hematuria syndrom
cogulation abnormality
excessive anticoagulation
Glomerular
IgA nehropathy
thin basement membrane disease (incl.Alport syndrome)
other causes of primary and secondary glomerulonephritis
Interstitial
allergic interstitial nephritis
analgesic nephropathy
renal cystic diseases
acute pyelonephritis
tuberculosis
renal allograft rejection
Uroepithelium
malignancy
vigorous excise
trauma
papillary necrosis
cystitis/urethritis/prostatitis (usually caused by infection)
parasitic diseases (e.g. schistosomiasis)
nephrolithiasis or bladder calculi
Multiple sites or source unknown
hypercalciuria
2
hyperuricosuria
2.System disorders
a. Hematological disorders:
aplastic anemia
leukemia
allergic purpura
hemophilia
ITP (idiopathy thrombocytopenic purpura)
b. Infection
infective endocarditis
septicemia
epidemic hemorrhagic fever (Hantaan virus)
-hemolytic streptococcus)
leptospirosis (leptospire)
filariasis (Wuchereria bancrofti, Brugia malayi
)
c. Connective tissue diseases
systemic lupus erythematosus (SLE)
polyarteritis nodosa
d. Cariovascular diseases
hypertensive nephropathy
chronic heart failure
renal artery sclerosis
e. Endocrine and metabolism diseases
gout
diabetes mellitus
3.Diseases of adjacent organs to urinary tract
appendicitis
salpingitis
carcinoma of the rectum
carcinoma of the colon
uterocervical cancer
4.Drug and chemical agents
sulfanilamides
anticoagulation
cyclophosphamide
mannitol
5.miscellaneous
Exercise
idopathic hematuria
3
CLINICAL FEATURE
Color :depends on the amount of red blood cell in the urine and the pH (see slide4) .
normal < <light yellow, pH 6.5
Ph: acidic: more darker (brown or black) alkaline: red
DIFFERENTIAL DIAGNOSIS
Polluted urine: menstruation
soy-like, very few RBC under the microscopy , occult blood test (+)
HEMOGLOBINURIA
RBC abnormality -Defects of RBC membrane structure and function (hereditary
spherocytosis) -Deficiency of enzymes (favism) -Hemoglobinopathy (thalassemia) -PNH
or mismatched blood transfusion
LABORATORY TESTS
-glass test
Method: collecting the three stages of urine of a patient during micturition Result: the initial
specimen containing RBC—the urethra the last specimen containing RBC—the bladder
neck and trianglar area, posturethra all the specimens containing RBC—upper urinary tract,
bladder
-contrast microscopy : to distinguish glomerular from post glomerular bleeding -
post glomerular bleeding: normal size and shape of RBC - glomerular bleeding: dysmorphic
RBC (acanthocyte)
ACCOMPANIED SYMPTOMS
Hematuria with renal colic
- Renal stone , ureter stone
- if with dysuria, miction pause or staining to void: bladder or urethra stone
Hematuria with urinary frequency,urgency and dysuria
- bladder or lower urinary tract (tuberculosis or tumor)
- if accompanied by high spiking fever, chill and loin pain: pyelonephritis
Hematuria with edema and hypertension
- Glomerulonephritis
- Hypertensive nephropathy
Hematuria with mass in the kidney
- neoplasm
- hereditary polycystic kidney
Hematuria with hemorrhage in skin and mucosa
- hematological disorders
4
- infectious diseases
Hematuria with chyluria
- filariasis