Hematuria

Hematuria is a medical condition in which different quantities of blood are found in the urine. Such findings are identified through the analysis of the urine samples, with the blood modifying the aspect of the urine. The condition is not dangerous on its own but it can be a symptom of different health problems, most often related to the kidneys. In general, doctors speak about hematuria, when the patient presents increased quantities of red blood cells in the urine (identified through urine analysis). This condition should be closely monitored by the doctor, as to ensure that it will not progress, signifying an aggravation of the underlying kidney or renal problem.

Hematuria Symptoms

These are the most common symptoms of hematuria:

• Coloration of the urine
  • Depending on the quantity of the red blood cells that are present in the urine – pink, red or brown
• Pain is present only when blood clots are passed through the renal system and eliminated through urine
• Other symptoms that indicate an underlying illness include:
  • Periorbital puffiness
  • Peripheral edema
  • Purpura or other rashes on the skin
  • Increased blood pressure (hypertension)
  • Reduced urinary output
  • Joint pain
  • Pallor of the skin
• In case of infection, systemic symptoms might also be present:
  • Fever
  • Nausea and vomiting
  • Abdominal pain
  • State of general weakness.

Causes

These are the most common causes that can lead to the appearance of hematuria:

• Infection of the urinary tract
  • Most common – bacterial infection
  • Frequent infection with E. Coli, Klebsiella pneumonia, Staphylococcus saprophyticus
• Stones at the levels of the renal system (kidneys, ureter or urinary bladder)
  • Condition known as nephrolithiasis
  • The passing of the stones can lead to the appearance of blood and blood clots into the urine (intense pain associated)
• Polycystic kidney disease
  • Genetic disorder involving the kidneys
  • Multiple cysts appear on the kidneys, being filled with liquid and leading to the chronic inflammation in the area
• Trauma or injury to the renal system
  • Can cause the elimination of blood from the respective injuries into the kidneys
  • If there is a lot of blood in the urine and the patient complains of a lot of pain, emergency surgical intervention might be necessary
• Neoplastic growths at the level of the renal system (may involve one or both kidneys, the urinary bladder or the ureter)
• Enlargement of the prostate
  • Condition known as benign prostatic hyperplasia
  • More commonly encountered in middle-aged men
  • The enlargement of the prostate can press down on the vessels of the renal system, causing them to break and blood to be eliminated into the urine
• Intense physical exercise
  • Condition often presented as athletic nephritis (mainly caused by an inflammatory process in the area)
  • This can lead to the breaking of the vessels of the renal system, with different quantities of blood being eliminated into the urine
• Idiopathic
  • No cause can be identified, despite the patient presenting the above-mentioned symptoms
• Less common causes
  • Glomerular bleeding
    • IgA nephropathy (Berger’s disease)
    • Alport syndrome
    • Thin basement membrane disease
  • Sickle cell anemia
  • Schistosomiasis
    • Responsible organism for the appearance of this disease – Schistosoma haematobium
    • Endogenous condition in Africa and the Middle East
  • Surgical intervention at the level of the urinary tract (recent)
  • Inflammation of the prostate
  • Inflammation of the ureter
  • Medical illnesses involving the kidneys or other parts of the renal system
  • AV fistula
    • Occurs at the levels of the kidneys
    • May resemble certain forms of cancer (renal cell carcinoma)
    • It is caused by an abnormal connection between an artery and a vein (arteriovenous malformation)
• Very rare causes include:
  • Paroxysmal nocturnal hemoglobinuria
    • Rare medical condition
    • Due to the hemolysis process, the red blood cells are eliminated into the urine
  • Glomeruli fibrinoid necrosis
    • Caused by the malignant increased blood pressure
  • Vesical varices
    • Rare complication that appears in patients who suffer from the obstruction of the inferior vena cava
  • Allergies
    • More common in children
    • The hematuria comes and goes (episodic)
  • Nutcracker syndrome
    • This condition is characterized by the increased blood pressure in the renal vein (more common in the left one)
    • Rare condition – vascular abnormality
    • Increased quantities of blood are eliminated through the urine
  • Ureteropelvic junction obstruction
    • Rare condition
    • Appears immediately after birth
    • Practically, the ureter is blocked between the urinary bladder and the ureter
    • May lead to the elimination of blood into the urine, among other symptoms
  • March hematuria
    • Appears in those who have been subjected to violent beatings (most commonly hit with the feet in the kidney area)
    • The repeated hits lead to damage of the renal system and the blood vessels, with blood being eliminated into the urine.

It is important to remember that taking certain medication (such as sulfonamides, quinones, phenytoin or rifampin), eating red-colored foods (such as beets) and menstruation can lead to the coloration of urine that resembles the one from hematuria. However, one should not mistake the coloration of urine for hematuria; it is for the best to consult the doctor and provide a urine sample for a thorough analysis. In this way, the diagnosis of hematuria can be confirmed for certain and the adequate treatment provided.

Treatment

These are the recommended measures of treatment for hematuria and its associated symptoms:

• Non-steroidal anti-inflammatory medication (NSAIDs)
  • Recommended choices – acetaminophen, ibuprofen, naproxen
  • Pain relief and reduction of inflammation (symptomatic treatment)
• Surgical intervention
  • Correction of anatomic abnormality
  • Treatment of ureteropelvic junction obstruction
  • Removal of cancerous growths from the kidney area
  • Removal of kidney, bladder or ureter stones that are too large to be passed on their own
• Antibiotics
  • Recommended in case of bacterial infections identified at the level of the urinary tract
  • These should be taken for as long as they prescribed, otherwise the bacteria will develop resistance to the treatment
  • Probiotics are recommended to be taken during the treatment with antibiotics, so as to maintain a healthy intestinal flora
• Specific medication for the enlargement of the prostate
• Chemotherapy and radiation therapy for cancerous growths that cause hematuria
• Diuretics to increase the overall urine output
• Medication to keep the blood pressure under control
• Medication to suppress the immune system – recommended for hematuria caused by autoimmune disorders
• Clotting factors for those who suffer from bleeding disorders, such as hemophilia.

As you have seen, the treatment measures are not directed straight at hematuria but rather at the underlying condition causing it. Once the underlying cause is treated, hematuria and the other associated symptoms will disappear on their own.