Isolated Hematuria

Red urine is not always hervorgerufe by erythrocytes. A red or reddish brown discoloration may be caused by:

Under a hematuria refers to erythrocytes in the urine, especially> 3 red blood cells / high power field on examination of urine sediment. Urine may be red, bloody or cola colored (gross hematuria) or not visible discolored (microscopic hematuria). Isolated hematuria means erythrocytes in the urine without other signs of urine abnormality (eg. Proteinuria, cylinder). Red urine is not always hervorgerufe by erythrocytes. A red or reddish brown discoloration may be caused by: (. Eg beets, rhubarb, sometimes food coloring) hemoglobin or myoglobin in the urine porphyria (most types) Food drugs (mostly Phenazopyridine, but sometimes cascara, diphenylhydantoin, methyldopa, phenacetin , phenindione, phenolphthalein, phenothiazine and Senna) pathophysiology erythrocytes can pass into the urine along the urinary tract from anywhere – from the kidneys, collection systems, ureters, prostate, bladder and urethra. Etiology Most cases involve a transient microscopic hematuria, which is self-limiting and idiopathic. A transient microscopic hematuria is particularly common in children and occurs in up to 5% of their urine samples before. There are numerous specific causes (see Table: Common specific causes of hematuria). The most common specific causes vary slightly by age, but overall are the most common UTI prostatitis urinary Physical (in adults) stress can cause temporary hematuria. Cancer and prostate diseases are mainly in patients is> 50 a problem, although younger patients with risk factors can develop cancer. Glomerular disease can be a cause at any age. Glomerular diseases can be primary renal diseases (acquired or congenital) or secondarily due to many causes, including infections (z. B. ?-hemolytic streptococcal infection of group A), connective tissue diseases (eg. B. SLE in all age groups, immunoglobulin-A associated vasculitis [Henoch-Schonlein purpura] in children) and blood diseases (eg. as mixed cryoglobulinemia, serum sickness). Worldwide IgA nephropathy is the most common form of glomerulonephritis. Schistosoma haematobium, a parasitic fluke that causes serious diseases in Africa (and to a lesser extent in India and parts of the Middle East), from entering the urinary tract and cause hematuria. Schistosomiasis is considered only when people have been in endemic areas. Mycobacterium tuberculosis can also infect the lower or upper urinary tract and cause hematuria, sometimes it can be examined cause urethral strictures. Common specific causes of hematuria cause suspicious findings diagnostic approach * Infection urogenital irritation, Sudden with or without fever urinalysis and urine culture urinary occurrence, usually colic, severe flank or abdominal pain, sometimes without contrast or sonography of the abdomen Glomerular with vomiting CT of the abdomen disease (zahlrei che forms) In many patients, hypertension, edema, or both may red or dark (cola colored) urine Sometimes prior infection, positive family Anamneses for kidney disease or connective tissue disease usually proteinuria urinalysis examination of urine sediment on red blood cell casts and dysmorphic erythrocytes Serological tests renal biopsy cancer (bladder, kidney , prostate, ureter) especially in patients> 50 or (with risk factors smoking, family history, chemical or drug [z. B. phenacetin, cyclophosphamide] exposures) Sometimes voiding symptoms with bladder cancer often systemic symptoms and renal cell cancer in men, PSA, pelvic and prostate ultrasound and biopsy in all patients cystoscopy prostate Especially in patients> 50 Often urogenital obstructive symptoms palpable enlarged prostate PSA measurement the residual urine volume sonography of the pelvis prostatitis especially in patients> 50 Often urogenital irritative and obstructive symptoms Painful, sensitive prostate Clinical evaluation Sometimes transrectal ultrasonography or cystoscopy Polycystic kidney disease Chronic and recurrent abdominal pain hypertension Large renal ultrasonography or CT of the abdomen without contrast Renal papillary necrosis infarction or often in people with sickle cell disease or- property (eg. As in blacks, v. a. in children and young adults, often with a known underlying disease) Sometimes heavy analgesia (analgesic nephropathy) Sometimes sickle cell preparation and Hb electrophoresis endometriosis hematuria coinciding with menstruation Clinical evaluation trauma (blunt or penetrating) Usually occurs as a violation, not as hematuria CT of the abdomen and pelvis flank pain haematuria syndrome flank pain hematuria CT Nutcracker syndrome hematuria left sided testicular pain varicocele CT angiography * All patients underwent urinalysis and evaluation of renal function are required, older patients require imaging of the kidneys and pelvis. PSA = prostate-specific antigen. Assessment history The history of the present illness includes duration of hematuria and all previous episodes. Urogenital obstructive symptoms (eg. As incomplete emptying, nocturia, difficulty starting or stopping urination) and irritative symptoms (eg. As irritation, urinary urgency, frequent urination, dysuria) must be observed. Patients should after the onset of pain, its location and severity are interviewed and whether they have physical activity intense. A review of organ systems should investigate possible causes symptoms including joint pain and rashes (connective tissue disease). Onset of fever, night sweats or weight loss should also be noted. The history should include questions about any recent infections, particularly strep throat, which may indicate a streptococcal infection of the beta-hemolytic group A. It should be looked for findings that are known for bleeding of the urinary tract to cause (especially kidney stones, sickle cell anemia and glomerular diseases). In addition, should conditions that predispose to a glomerular disease, such as a connective tissue disease (especially SLE and RA), endocarditis, shunt infections, and abdominal abscesses, are identified. Risk factors for Urogenitalkarzinome should be identified, including smoking (the most important), drugs (eg., Cyclophosphamide, phenacetin) and exposure to industrial chemicals (eg., Nitrates, nitrilotriacetate, nitrites, trichlorethylene). With a family history of relatives should be detected with polycystic kidney disease, glomerular disease or Urogenitalkarzinom Patients should to travel to areas where schistosomiasis is endemic in demand and risk factors for TB are assessed. When drug history, the use of anticoagulants or antiplatelet agents should (though controlled anticoagulation not itself cause hematuria) and heavier use of painkillers examined werden.Körperliche Exam Vital signs should be checked for fever and high blood pressure. The heart should be on noise (suggestive of endocarditis) are monitored. The abdomen should be scanned by space-occupying lesions; Edges should be tapped via the kidneys sensitivity. In men, a digital rectal examination should be performed to exclude a prostate enlargement, nodes, and sensitivity. The face and extremities should on edema (the evidence of glomerular disease type) and skin rashes on (the vasculitis, SLE or immunoglobulin-A-associated vasculitis indicate) examined werden.Warnzeichen The following findings are of particular importance: gross hematuria persistent microscopic hematuria, especially in elderly patients aged> 50 hypertension and edema systemic symptoms (eg., fever, night sweats or weight loss) interpretation of the findings Clinical manifestations of various causes overlap considerably, so that urine and often blood tests are required. Depending on the result, imaging tests may be necessary. However offer some helpful hints clinical findings (see Table: Common specific causes of hematuria). Blood clots in the urine Close essentially a glomerular disease from. Glomerular diseases are often accompanied by edema, hypertension, or both; Infection can symptoms precede (in particular one of ?-hemolytic streptococcal infection of group A in children). Calculi manifest themselves usually with excruciating, colicky pain. A less severe, constant pain is probably due more ago by an infection, cancer, polycystic kidney disease, glomerulonephritis and flank pain haematuria syndrome. Urogenital irritative symptoms indicate a bladder or prostate infection, but may be associated symptoms of certain types of cancer (especially bladder and prostate cancer). Urogenital obstructive symptoms suggest a rule on prostate disease. An abdominal mass is due to polycystic kidney disease or renal cell carcinoma. A family history of nephritis, sickle cell disease or polycystic kidney disease suggests this as a cause. Travel to Africa, the Middle East or India may indicate a schistosomiasis. Systemic symptoms (eg., Fever, night sweats, weight loss) can be a sign of cancer or subacute infection (z. B. TB). On the other side require frequent findings (z. B. prostate enlargement, excessive anticoagulation), even if hematuria may be due to them werden.Tests not simply accepted without further investigation as a cause before the tests should be a real hematuria of red urine be distinguished by means of urine analysis. In women with vaginal bleeding, the sample should be taken by direct catheterization in order to prevent contamination by a nichturogenitale blood source. Red urine without the detection of red deuet indicate myoglobinuria or hemoglobinuria, porphyria, or taking certain medications or food. I. General. the diagnosis of hematuria by a second sample should be confirmed. Cylinder, protein or dysmorphic erythrocytes (oddly shaped, with needles, wrinkles and bubbles) show a glomerular disease. Leukocytes or bacteria indicate an infectious etiology. However, since urine analyzes show in some patients with cystitis mainly erythrocytes, a urine culture is created. A positive culture result requires treatment with antibiotics. Suspended hematuria after treatment and there are no other symptoms in patients <50 years, v. a. required in women, no further investigation. If (including children) a microscopic hematuria in patients <50 detected only and do not let urine findings involved an glomerular disease, no causal clinical manifestations are present and there are no risk factors for cancer, they can with every 6-12 months to repeat urinalysis to be observed. If hematuria persists, sonography or CT are recommended with contrast. with gross hematuria or unexplained symptoms sonography or CT of the abdomen and pelvis are required in patients <50th When urine or clinical findings indicate a glomerular disorder, renal function is evaluated by measurement of BUN, serum creatinine and electrolytes; performed a urine analysis and determined at regular intervals of the protein / creatinine ratio in the urine. Further evaluation of glomerular disease requires serological testing, biopsy of the kidney or both. All patients ? 50 years of age must be zystoskopiert; the same is true for patients <50 years old who have a family history of cancer or systemic symptoms. Men ? 50 must be tested for prostate specific antigen at elevated levels further clarification in relation to prostate cancer is needed. The therapy treatment depends on the particular cause. Conclusion Red urine should be distinguished from a hematuria (red blood cells in the urine). A urinalysis and examination urine sediment are helpful to glomerular be distinguished from non-glomerular causes. The risk of serious disease increases with age and with the duration and degree of hematuria. Cystoscopy and imaging tests are required or generally for patients> 50 for younger patients with systemic symptoms or risk factors for cancer.

Health Life Media Team

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