Xiao Wang is 26 years old this year, and early in the morning, he took an emergency registration form and ran to the doctor in a panic: I may have a big problem.
The doctor asked, "Where are you uncomfortable?" ”
Xiao Wang wanted to talk many times, and finally whispered, "When I got up to go to the toilet in the morning, I found that there was blood in the urine..."
After saying that, Xiao Wang's various inner dramas began to be staged: Even there is blood in the urine, am I about to die?
Source: Stand Cool Helo
With blood in the urine, what is the reason for this problem that makes Xiao Wang restless? Is it serious?
After some inquiry, the doctor learned that the original Xiao Wang visited the supermarket the night before, found the supermarket red heart dragon fruit discount promotion, and then bought a lot of red heart dragon fruit, and then went home, all ... eat... finish......
Some vegetables and fruits, especially red heart dragon fruit and beets, have a high content of natural pigments, and sometimes they can dye people's urine red, and even dye their stools red, looking like bloody stools. (It turns out that the truth of "hematuria" is like this!) ）
In fact, there are many causes of redness in urine, and the color is different. For example, temporary transient, there are also pathological hematuria. Don't panic just because you see blood in your urine.
Temporary hematuria can sometimes occur in healthy people after strenuous exercise, heavy physical exertion, cold showers, or prolonged standing.
Some people eat some kind of colored vegetables and fruits, and their urine may also turn red.
Certain drugs and their metabolites, such as rifampicin, phenytoin, phenthiazide, etc., can also cause urine to turn red. (Rifampicin, a purple-red crystalline powder, can make the urine red or orange-red after oral use of rifampicin, but after routine urinalysis, no red blood cells are found in the urine.) ）
Hematuria is a common clinical phenomenon. Detection rates of microscopic hematuria range from 1% to 18%, depending on the patient's age, sex, frequency of detection, and the presence of risk factors[1][2][3]. Pathological hematuria, which can be caused by a variety of causes, requires detailed differentiation and differentiation.
Source: Stand Cool Helo
In general, hematuria is divided into microscopic hematuria and gross hematuria.
A random urine is left in a normal person, and if it is not centrifuged and concentrated, it is difficult to observe red blood cells under the microscope. After urine centrifugation and concentration, red blood cells can be seen occasionally in the high magnification field of view, and under normal circumstances, centrifuged urine generally does not exceed 3/HPF.
When the urine is centrifuged and precipitated, when there are> 3 red blood cells in each high-magnification field of vision under the microscope, it is called microscopic hematuria, and the naked eye generally cannot see that the urine becomes obvious blood color.
When the blood content in 1L urine is more than 1mL, the naked eye can observe that the urine is red, which is called gross hematuria in medicine.
According to the morphology of urine red blood cells, hematuria can be divided into three types.
1. Homogeneous erythrocyte hematuria
At this time, the > of red blood cells in the urine is 8000/mL. More than 70% of erythrocytes are normal in appearance and size, and the erythrocyte membrane is intact. Erythrocyte morphology is single.
Most are non-glomerular hematuria. It mainly refers to bleeding in the parts below the glomerular and urinary pathways, mostly due to rupture of capillaries, and red blood cells do not pass through the glomerular basement membrane rifts, so the morphology can be normal and homogeneous [4].
Erythrocytosis is dominant, and urine protein does not increase or increase is not obvious.
As shown in the figure below, under a light microscope, the morphology of red blood cells is basically normal.
Source: Diagnostic Atlas of Clinical Laboratory Tests
2. Heterogeneous erythrocyte hematuria (deformed erythrocyte hematuria)
At this time, the > of red blood cells in the urine is 8000/mL. But more than 70% of red blood cells have more than two types of deformation, and red blood cells show three types of morphological changes: changes in size; morphological abnormalities; and changes in hemoglobin content.
Mostly glomerular hematuria, because erythrocytes pass through the pathologically altered glomerular basal membrane, they are crushed and affected by different pH and osmotic pressure changes, cell size is not large, hemoglobin content is different, cell membrane changes are large, and shadow cells and spiny cells with different sizes and morphologies appear, and the polymorphic changes of red blood cells often exceed 50% [5].
Often accompanied by increased urine protein, granular casts, red blood cell casts, renal tubular epithelial cells, etc.
In the figure below, under the optical microscope, the volume of red blood cells is large and varies in size, and most of the cells become wrinkled and the wheels are serrated. Associated with changes in urine specific density and osmotic pressure [6].
Source: Diagnostic Atlas of Clinical Laboratory Tests
3. Mixed hematuria
At this time, the urine contains both homogeneous and non-homogeneous erythrocytes.
1. Homogeneous hematuria:
Temporary microscopic hematuria: strenuous exercise, prolonged standing, cold bath, heavy physical exertion.
Urinary system diseases: such as urinary system inflammation, stones, tuberculosis, tumors, kidney transplant rejection, congenital urinary tract malformations, trauma, etc. Left renal venous compression syndrome, renovascular diseases, such as renal vein thrombosis, arteriovenous fistula, etc. Drugs cause kidney and bladder damage, such as cyclophosphamide [7].
Diseases of the reproductive system: prostatitis, vesiculitis, etc.
Systemic diseases: infectious diseases; endocrine metabolic diseases; blood diseases such as thrombocytopenic purpura, hemophilia; cardiovascular diseases, connective tissue diseases.
Types of kidney stones, source: Stand Ku Helo
2. Heterogeneous hematuria:
Common in acute glomerulonephritis, chronic glomerulonephritis, pyelonephritis, lupus erythematosus nephritis, nephrotic syndrome, etc.
3. Mixed hematuria
Bleeding is mostly not of a site, has glomerular hematuria, and may be accompanied by non-glomerular hematuria. There are not many diseases that cause mixed hematuria, and IgA nephropathy is the first.
What tests do I usually do when hematuria occurs?
Different reasons often require different examinations, when there are symptoms of hematuria discomfort, you can go to the local regular hospital for treatment, and the doctor chooses different examination methods according to the needs of the condition. There are several common tests, as well as other tests, which the doctor will determine according to the needs of the condition.
1. Urine routine plus sediment microscopy:
Urine routine test has whether there is urine protein, and urine sediment is observed for whether there are red blood cell casts, granular casts, white blood cell casts, etc.
2. Urine red blood cell phase:
More than 70% of erythrocytes are abnormal (malformed or polycyclic) and can be identified as glomerular hematuria.
3. Urine three-cup test:
At present, it is not commonly used in clinical practice, and the first, middle and final stages of urine are collected for naked eye observation and microscopic examination.
If hematuria is dominated by the first cup, it is mostly urethral bleeding, such as inflammation, foreign body, stones, polyps or urethral injury to the penile segment;
Hematuria is mainly urinated in the third cup, or dripping blood is common in mostly bladder bleeding.
If all three cups have hematuria, it is more common to bleed from the kidneys or ureters.
4. Urine bacteriological examination:
Patients with symptoms consistent with urinary tract infections should be left clean to interrupt urine, bacterial cultures, and drug susceptibility tests.
When urinary tract tuberculosis is suspected, centrifugation is required to concentrate the urine, smear acid-resistance staining, and look for acid-fast bacilli. In order to improve the detection rate, urine samples should be sent for testing more than 3 times in a row.
5. CT scan.
6.B Super check.
7. Intravenous pyelography (IVP).
8. Renal cytology and histological examination.
There are many causes of hematuria, different etiology, different clinical symptoms, and different test results. If hematuria occurs, seek medical treatment in time, and the doctor will comprehensively analyze and judge according to the medical history, physical examination and auxiliary examination results. For detailed steps, see figure below[8].
Take a reasonable break and avoid strenuous exercise.
If hematuria occurs, do not panic, actively go to the local regular hospital for treatment, and the doctor will judge whether it is temporary hematuria or pathological hematuria. If it is pathological hematuria, under the guidance of a doctor, actively treat the cause and symptoms.
bibliography
[1] Avellino, G.J., S. Bose, and D.S. Wang, Diagnosis and Management of Hematuria. Surg Clin North Am, 2016. 96(3): p. 503-15.
[2] Bolenz, C., et al., The Investigation of Hematuria. Dtsch Arztebl Int, 2018. 115(48): p. 801-807.
[3] Donehower, L.A., et al., Integrated Analysis of TP53 Gene and Pathway Alterations in The Cancer Genome Atlas. Cell Rep, 2019. 28(5): p. 1370-1384 e5.
Xiong Lifan,Liu Chengyu. Fundamentals of Clinical Laboratory, 4th Edition, People's Medical Publishing House, 2007, 174-176.
Wan Xuehong,Lu Xuefeng. Diagnostics (8th Edition of Five-Year System), People's Medical Publishing House, 2013, 316-317.
Wang Jianzhong, Atlas of Clinical Laboratory Diagnostics, People's Medical Publishing House, 2012, 578-580.
Zhou Jieqing,Jiang Hong. Etiology and mechanism of hematuria[J]. CJPP, 2014, 29(4):245-248.
Liu Fengkui,Chen Haiping. Clinical diagnosis of hematuria[J].Chinese Journal of Clinicians,2016,44(2):22-25.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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