Haematuria

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Haematuria-প্রস্রাবে রক্ত যাওয়া

Haematuria is the presence of blood in the urine, either visible (seen by the naked eye) or non-visible (confirmed by urine dipstick or urine microscopy).

It is never a normal finding and has a range of urological and non-urological causes, both malignant and benign, which commonly require further investigation.

Types of hematuria:

1. Gross hematuria: When there is the presence of frank blood in the urine, it can be seen with the naked eye. This is called as gross hematuria.

2. Microscopic hematuria: This kind of hematuria is characterized by the presence of RBC (red blood cells) in the urine. But RBCs are seen only when the urine is examined under the microscope. The color of the urine does not change and the patient cannot see blood to the naked eye.

Causes of hematuria:

Urinary tract infections. These occur when bacteria enter your body through the urethra and multiply in your bladder. Symptoms can include a persistent urge to urinate, pain and burning with urination, and extremely strong-smelling urine.

For some people, especially older adults, the only sign of illness might be microscopic blood in the urine

Kidney infections (pyelonephritis). These can occur when bacteria enter your kidneys from your bloodstream or move from your ureters to your kidney(s). Signs and symptoms are often similar to bladder infections, though kidney infections are more likely to cause a fever and flank pain.

A bladder or kidney stone. The minerals in concentrated urine sometimes form crystals on the walls of your kidneys or bladder. Over time, the crystals can become small, hard stones.

The stones are generally painless, so you probably won't know you have them unless they cause a blockage or are being passed. Then there's usually no mistaking the symptoms — kidney stones, especially, can cause excruciating pain. Bladder or kidney stones can also cause both gross and microscopic bleeding

Enlarged prostate. The prostate gland — which is just below the bladder and surrounding the top part of the urethra — often enlarges as men approach middle age. It then compresses the urethra, partially blocking urine flow. Signs and symptoms of an enlarged prostate (benign prostatic hyperplasia, or BPH) include difficulty urinating, an urgent or persistent need to urinate, and either visible or microscopic blood in the urine. Infection of the prostate (prostatitis) can cause the same signs and symptoms.

Kidney disease. Microscopic urinary bleeding is a common symptom of glomerulonephritis, an inflammation of the kidneys' filtering system. Glomerulonephritis may be part of a systemic disease, such as diabetes, or it can occur on its own. Viral or strep infections, blood vessel diseases (vasculitis), and immune problems such as IgA nephropathy, which affects the small capillaries that filter blood in the kidneys (glomeruli), can trigger glomerulonephritis.

Cancer. Visible urinary bleeding may be a sign of advanced kidney, bladder or prostate cancer. Unfortunately, you might not have signs or symptoms in the early stages, when these cancers are more treatable.

Inherited disorders. Sickle cell anemia — a hereditary defect of hemoglobin in red blood cells — causes blood in urine, both visible and microscopic hematuria. So can Alport syndrome, which affects the filtering membranes in the glomeruli of the kidneys.

Kidney injury. A blow or other injury to your kidneys from an accident or contact sports can cause visible blood in your urine.

Medications. The anti-cancer drug cyclophosphamide and penicillin can cause urinary bleeding. Visible urinary blood sometimes occurs if you take an anticoagulant, such as aspirin and the blood thinner heparin, and you also have a condition that causes your bladder to bleed.

Haematuria

Investigations

• Urine C/S
• RFT
• CBC

1. Reduceed Hb: Bleeding, HUS, SLE, CRF
2. Abnormal TC/DC: Infections, HUS

• Platelet counts & Coagulation studies: Bleeding disorders, Sickle cell
• PS : Microangiopathic haemolytic anemia
• ESR, CRP : Infections
• 24 hrs Urinary protein, Spot PCR, Sr.Albumin, Sr.Cholesterol & associated Proteinuria ( Nephrotic ).
• Urine Calcium : 24 hrs urinary ca > 4mg/kg/dl or spot urine calcium creatinine ratio >0.21 (Hypercalciuria )

1. Berberis Vulgaris- For Blood in Urine Because of Kidney Stones

2. Lycopodium- Specially right sided renal stones: 

3. Cantharis- For Blood in Urine Accompanied by Burning Urination

4. Apis Mellifica-

5. Nitric Acid- For Blood in Urine Accompanied by Offensive Urine

6. Uva Ursi- For Blood in Urine Accompanied by Sticky Mucus