Hematuria
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血尿 ( Hematuria ). 原南京中大附属医院神内科主任、硕士生导师 佛山大学医学院医学系孟红旗教授、主任医师 Professor 、 Doctor director 、 Neurologist. CONTENT. Definition of hematuria Etiology Clinical feature Differential diagnosis Laboratory tests Accompanied symptoms. DEFINITION.

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血尿 ( Hematuria )

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Hematuria

ProfessorDoctor director Neurologist


CONTENT

  • Definition of hematuria

  • Etiology

  • Clinical feature

  • Differential diagnosis

  • Laboratory tests

  • Accompanied symptoms


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


  • RBC>3/HPAddis12RBC>50 1>10


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


  • microhematuria

    macrohematuria



ETIOLOGY

  • Diseases of the urinary systemthe most common cause

    1Vascular

    arteriovenous malformation

    arterial emboli or thrombosis

    arteriovenous fistular

    renal vein thrombosis

    loin-pain() hematuria syndrom

    excessive anticogulation


2Glomerular

IgA nehropathy

thin basement membrane disease (incl.Alport syndrome)

other causes of primary and secondary glomerulonephritis

3Interstitial

allergic interstitial nephritis

analgesic() nephropathy

renal cystic diseases

acute pyelonephritis

tuberculosis

renal allograft rejection


4Uro-epithelium

malignancy vigorous excise

trauma

papillary necrosis

cystitis/urethritis / prostatitis (usually caused by infection)

parasitic diseases (e.g. schistosomiasis)

nephrolithiasis() or bladder calculi


  • 5System disorders

    a. Hematological disorders

    anemia leukemia

    allergic purpura hemophilia()

    ITP (idiopathy thrombocytopenic purpura)

    b. Infection

    infective endocarditis

    septicemia

    epidemic hemorrhagic fever (Hantaan virus)

    scarlet fever (-hemolytic streptococcus)

    leptospirosis()

    filariasis()


c. Connective tissue diseases

systemic lupus erythematosus (SLE)

d. Cariovascular diseases

hypertensive nephropathy

chronic heart failure

renal artery sclerosis

e. Endocrine and metabolism diseases

gout

diabetes mellitus


  • 6Diseases of adjacent organs to urinary tract

    appendicitis

    carcinoma of the rectum

    carcinoma of the colon

    utero-cervical cancer

  • 7Drug and chemical agents

    sulfanilamides anticogulation

  • 8miscellaneous

    exercise

    idopathic hematuria


1 Local

a. Infection

b. Tumour esp. >40 y/o

c. Stone

d. Trauma

e. Prostatic disease

f. Hemorrhagic cystitis

the most common Causes of Haematuria

2.General

a.Bleeding diatheses

b.Unusual causes

Endocarditis

Polyarteritis nodosa

Malignant hypertension

Glomerulonephritis


Origin of haematuria

1.Kidney 15%

2.Ureter 15%

3.Bladder 40%

4.Prostate 25%

5.Urethra 5%


  • 1.

    IgA

    Alport


2. -

3.

4.


  • 1.

    2.


  • 1.

    2.

    3.


  • 11,1.2.3.


  • 4812*10^9/L,5-6/Hp,+++/Hp,,,,564-2


  • 4


CLINICAL FEATURE

  • 1Color

    depends on the amount of red blood cell in the urine and the pH

    normal: light yellow, pH 6.5

    pH

    acidic: more darker (brown or black)

    alkaline: red


DIFFERENTIAL Color

  • Polluted urine: menstruation

  • Drug and food: phenosulfonphtha lein (PSP), uric acid, vegetable

  • Porphyrism(): porphyrin in urine (+)

  • Hemoglobinuria

    hemolysis

    soy-like, very few RBC under the microscopy

    occult blood test (+)


2Three-glass test

Method: collecting the three stages of urine of a patient during micturition

Result:

  • the initial specimen containing RBCthe urethra

  • the last specimen containing RBCthe bladder neck and trianglar area, posturethra

  • all the specimens containing RBCupper urinary tract, bladder


3Phase-contrast microscopy

to distinguish glomerular from post glomerular bleeding

  • post glomerular bleeding: normal size and shape of RBC

  • glomerular bleeding: dysmorphic RBC (acanthocyte)


EXAMPLE OF PHASE-CONTRAST MICROSCOPY TEST (non-glomerlar


EXAMPLE OF PHASE-CONTRAST MICROSCOPY TEST (glomerlar)


  • 1000ml1ml


()


3

pH


  • 401.5cm1.5cm


ACCOMPANIED SYMPTOMS

  • Hematuria with renal colic

    renal stone, ureter stone

    if with dysuria, miction pausebladder 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

    infectious diseases



  • 20036703BKUB+IVP1CMCT2KUB+IVP1CT21.





X


KUB


Intravenous pyelography (urography), excretory pyelographyPlain film + 5-10, 30, full, post-voiding


IVP


IVP


Retrograde Pyelography


Stone formation within kidneyMigrated to ureter acute ureteral obstruction renal colics


Transitional cell carcinoma, derived from urothelium



  • 601010cm5


frequent micturition, urgent micturition, odynuria


CONTENT

  • Definition

  • Etiology and clinical appearance

  • Accompanied symptoms

  • Approach to the patient


Definition

  • Frequent micturition:

    voiding() at a frequent intervals, due to a sense of bladder fullness

    Normal: 3-5 times in the day time

    0-2 time in the night

    200-400ml each time


Definition

  • Urgent micturition:

    an exaggerated sense of needing to urinate due to an irritable or inflamed bladder

  • Dysuria:

    pain or a burring sensation during micturition

    irritation sign of bladder


  • 4602200400ml


ETIOLOGY AND CLINICAL APPEARANCEFrequent micturition

A.micturition increased but the volume each time is normal

  • diabetes mellitus.

  • polyuria period of acute renal failure

  • diabetes insipidus


  • 1.

    2. :


  • 1.1mmol/L


Frequent micturition

B. micturition increased and the volume each time is decreased.

  • bladder or urethra irritation:

    bladder,post urethral inflammation

    bladder tuberculosis or stone.(esp TB, frequent micturition can last for long time)


Frequent micturition

  • diminished capacity of bladder:

    neoplasm

    contracture of the bladder(TB)

    pregnant uterus

    hysteromyoma press on the bladder

    hysteroptosis


Frequent micturition

  • obstruction of the lower urinary tract:

    prostatic hyperplasia

    often seen in man after age 40 accompanied by force of the urinary system, hesitancy()in initiating voiding, post voiding dribbling and the sensation of incomplete emptying


Frequent micturition

  • neurogenic bladder:

    history of neurologic disease

  • psychogenic cause:

    nervous, worry, dread.


b)


TB


Urgent micturition

  • acute cystitis, urethritis, prostatitis, ureter stone, bladder cancer, neurogenic bladder etc.

  • urgency is commonly associated with frequency and dysuria.


Odynuria

  • urethritis, cystitis, prostatitis, bladder tuberculosis, stone, foreign body, end-stage bladder cancer

    urethritis--

    dysuria occurs at the beginning of micturition.

    cystitis--

    can be aggravated the pain at the end of micturition.


Odynuria

prostatitis--

can also cause discomfort in the lower abdomen, groin, perineum, rectum, testes or penis.

bladder calculi or foreign body--

voiding pause during micturition.

bladder tuberculosis--

concomitant with evidence of TB and hematuria



  • 12367103ivp


  • 681010B2.1*1.8CM31.2.3.


  • 1BPH:1100ml30gTURP


  • 9KUBIVP46cm112DJ15cm2


  • 21 / 2 3 4


ACCOMPANIED SYMPTOMSfrequency, urgency and dysuria

  • with fever and pyuria: acute cystitis

  • discomfort in the lower abdomen, groin, testes:

    acute prostatitis

  • with hematuria and evidence of systemic TB:

    bladder TB


  • frequency, urgency and aggravated pain at the end of micturition:

    stone in the lower part of ureter

  • male with age over 50,frequency and progressive straining to void:

    prostatic hyperplasia

  • patients over 40 years old hematuria without pain or hematuria appearing after the fuequency, urgency, dysuria:

    bladder cancer


  • with the history of neurologic diseases and signs:

    neurogenic bladder



  • 818310310


  • 5~6mm10mm8


Approach to the patient

PE- incl.pelvic

prostatic

history-past and present urinary problems

DIAGNOSIS

urinary analysis, leukorrhea prostatic fluid , culture , ultrasound, excretory urography, voiding cystourethrography

urologic evaluation-cystoscopy, urethroscopy, endoscopic biopsy, dynamic urinary tract studies



  • X


  • .84,"".,:BP120/60mmHg,,,,:.,20MG,,BP70/40mmHg,,80/50mmHg,4,:,,..


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