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Haematuria: Difference between revisions
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<section begin="urology" /><section begin="clinical biochemistry" />'''Haematuria''' refers to the presence of blood in the urine. We distinguish between microscopic haematuria, when the concentration of blood is too low to be macroscopically visible, and macroscopic haematuria, where the concentration is so high that the urine is visible coloured red. Haematuria is defined as the presence of > 3 RBCs per field of view at 400x when examining a urine sample under the microscope, or by it's detection by laboratory methods. | <section begin="urology emergency" /><section begin="urology" /><section begin="clinical biochemistry" />'''Haematuria''' refers to the presence of blood in the urine. We distinguish between microscopic haematuria, when the concentration of blood is too low to be macroscopically visible, and macroscopic haematuria (also called gross haematuria), where the concentration is so high that the urine is visible coloured red. Haematuria is defined as the presence of > 3 RBCs per field of view at 400x when examining a urine sample under the microscope, or by it's detection by laboratory methods. | ||
Haematuria may be a sign of kidney or urinary tract pathology, including [[glomerulonephritis]], [[urinary tract infection]], and [[bladder cancer]]. In many, however, haematuria is transient or no underlying pathology can be found. | Haematuria may be a sign of kidney or urinary tract pathology, including [[glomerulonephritis]], [[urinary tract infection]], and [[bladder cancer]]. In many, however, haematuria is transient or no underlying pathology can be found. | ||
Severe gross haematuria, especially when there is concurrent [[Acute urinary retention|urinary retention]] or voiding of blood clots, is a urological emergency as it may cause [[bladder tamponade]]. | |||
<section begin="urology emergency" /> | |||
== Etiology == | == Etiology == | ||
We distinguish two types of haematuria, glomerular haematuria and nonglomerular haematuria. Glomerular haematuria is secondary to glomerular disease. Nonglomerular haematuria is much more common. | <section end="urology emergency" />We distinguish two types of haematuria, glomerular haematuria and nonglomerular haematuria. Glomerular haematuria is secondary to glomerular disease. Nonglomerular haematuria is much more common. | ||
* Glomerular haematuria - due to [[glomerulonephritis]] | * Glomerular haematuria - due to [[glomerulonephritis]] | ||
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** [[Urolithiasis]] | ** [[Urolithiasis]] | ||
** [[Benign prostatic hyperplasia]] | ** [[Benign prostatic hyperplasia]] | ||
<section begin="urology emergency" /> | |||
Gross haematuria: | |||
* Urological surgery | |||
* Haemorrhagic cystitis | |||
<section end="urology emergency" /> | |||
== Classification == | == Classification == | ||
Macroscopic haematuria, also called macrohaematuria or gross haematuria, is the name of haematuria where the reddish colour change of the urine is visible to the naked eye. This is due to a high concentration of blood per unit urine. | Macroscopic haematuria, also called macrohaematuria or gross haematuria, is the name of haematuria where the reddish colour change of the urine is visible to the naked eye. This is due to a high concentration of blood per unit urine. | ||
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|> 500 mg/day | |> 500 mg/day | ||
|< 500 mg/day | |< 500 mg/day | ||
|}<section end="urology" /> | |} | ||
<section begin="urology emergency" /> | |||
== Management == | |||
In most cases haematuria doesn't directly require management, as it's more a sign of disease than a problematic thing in itself. The exception is severe gross haematuria, which can cause [[bladder tamponade]]. Severe gross haematuria must be managed with bladder catheterisation with a large lumen 3-way catheter to provide continous irrigation of the bladder with saline. The bladder can also be manually irrigated with a syringe. Cystoscopy may be necessary for clot evacuation and for stopping the bleeding source with cautery or ablation. | |||
For cases which are uncontrolled despite cystoscopy, embolisation of the bleeding artery is an option, as is intravesical [[tranexamic acid]]. The last resort is [[cystectomy]].<section end="urology emergency" /><section end="urology" /> | |||
[[Category:Nephrology]] | [[Category:Nephrology]] | ||
[[Category:Urology]] | [[Category:Urology]] | ||