How about urine with red blood cells during physical examination? Is it serious?

Hematuria refers to the abnormal increase of red blood cell excretion in urine, which is a signal that there may be serious diseases in the urinary system. Hematuria is defined as abnormal increase of red blood cells in urine, centrifugal precipitation with urine field of vision ≥3 red blood cells per high magnification, or non-centrifugal urine exceeding 65,438+0 or 65,438+0 hours, urine red blood cell count exceeding 654,38+0 million, or urine sediment count exceeding 500,000 hours. In mild cases, only erythrocytosis is found under the microscope, which is called hematuria under the microscope; In severe cases, the appearance is watery or contains blood clots, which is called gross hematuria. Usually, when there is 1 ml of blood in every liter of urine, it can be seen by naked eyes, and the urine is red or has a meat washing water sample.

[Causes of hematuria]

More than 95% hematuria is caused by diseases of the urinary system itself, including glomerular diseases (acute nephritis, acute nephritis, membranous proliferative nephritis, mesangial proliferative nephritis, focal glomerulosclerosis, etc. ), renal cyst, calculus (kidney, ureter, bladder, urethral calculus), prostatic hyperplasia, urinary tract infectious diseases (tuberculosis, pyelonephritis, seminal vesiculitis, prostatitis), tumor (prostatitis). Other diseases such as abnormal coagulation (idiopathic or drug-induced thrombocytopenia, hemophilia, scurvy, etc. ) and systemic diseases (aplastic anemia, leukemia, systemic lupus erythematosus, dermatomyositis, leptospirosis, epidemic hemorrhagic fever, etc. ) can also cause hematuria.

Blood in urine is hematuria, also called hematuria.

Under normal circumstances, there are no red blood cells in urine. After the patient's urine is centrifugally precipitated in medicine, it is examined by microscope. If there are more than 5 red blood cells in each high-powered field, it is called hematuria. If only red blood cells are detected under the microscope, but the eyes can't see the urine with blood, it is called hematuria under the microscope; If the eyes can see that the urine is "watery" or bloody, or even there are bloodshot or blood clots in the urine, it is called gross hematuria. So hematuria is not always found with the naked eye. You can see blood in the urine with your eyes. About 1000 ml of urine is mixed with at least 1 ml of blood, indicating that hematuria is serious, so we should find out the cause and treat it actively.

(A) the cause of hematuria

Hematuria is often caused by diseases of urinary organs. Human urine is produced in the kidney and excreted through the renal pelvis, ureter, bladder and urethra. Any disease and bleeding of these organs will cause hematuria.

Common diseases that cause hematuria include nephritis, urinary system infection, hemorrhagic cystitis, urinary calculi, renal tuberculosis, renal tumor, renal and urethral injury, etc. Hematuria is one of the main symptoms of these diseases.

(2) Differential diagnosis of hematuria

When micturition begins with hematuria and the urine in the latter part is normal, it is generally a urethral disease; If micturition begins to be normal, hematuria will eventually appear, mostly cystitis and prostate disease; If it is "total hematuria", the blood color is dark red, which is generally caused by kidney disease. Urinating blood rarely shows shock.

Hematuria is common in the following diseases:

1? One week before the onset of acute glomerulonephritis hematuria with oliguria, proteinuria, edema, hypertension and tonsillitis.

2? Pyelonephritis, hematuria with dysuria, urgency, frequent urination, low back pain and fever.

3? Urinary calculi are characterized by hematuria with renal colic, or with symptoms such as interruption of urination, dysuria and dysuria.

4? More than 90% of patients with renal tuberculosis have hematuria, which is characterized by urgency, frequent urination and dysuria.

5? Kidney and urinary tract injuries often have a history of waist or abdomen injuries, such as contusion, collision and fall.

6? Henoch-Schonlein purpura is a disease with bleeding spots, gastrointestinal bleeding and joint pain. Hematuria appears 2 ~ 4 weeks after the skin has bleeding spots.

7? Systemic diseases such as vitamin C and vitamin K deficiency, and hematological diseases such as leukemia and hemophilia can all cause hematuria.

8? Drug-induced hematuria Some drugs are harmful to the kidneys and can cause hematuria after taking them. Such as gentamicin, tetracycline, sulfonamides, kanamycin, etc.

9? Temporary hematuria is caused by drinking too little water, and it will disappear quickly after increasing the amount of drinking water and diluting urine.

(3) Rescue measures

(1) Stay in bed and minimize strenuous activities. If necessary, you can take phenobarbital, diazepam and other sedative sleeping pills.

(2) Drink plenty of water to reduce the crystallization of salt in urine and accelerate the excretion of drugs and stones. People with nephritis and edema should drink less water.

(3) Use hemostatic drugs, such as Anluoxue, Zhixuemin, vitamin K, vitamin C, etc.

(4) Use drugs that cause hematuria with caution, especially those with existing kidney diseases.

(5) Hematuria is caused by urinary tract infection. Antibiotics and urinary tract cleaners, such as norfloxacin, furacilin, ampicillin, penicillin, metronidazole, etc., can be taken orally or injected.

(6) Urinary stones often have severe abdominal pain, and belladonna tablets and 654 can be taken orally. 2. Atropine relieves spasm and pain.

(7) The cause of hematuria is complicated, and some cases are very serious. We should go to the hospital as soon as possible for diagnosis and thorough treatment. Unilateral nephrectomy is feasible after the diagnosis of renal tuberculosis and renal tumor, so as to achieve the goal of radical cure.

References:

Causes of hematuria

More than the normal amount of blood in urine is called hematuria. If 1000 ml urine contains 1 ml smoke, the urine looks like a blood sample or a meat washing water sample to the naked eye, which is called gross hematuria. In routine urine examination, if there are more than five red blood cells in the high magnification field under the microscope, or the Aidi count of urine in 12 hour exceeds100000, which cannot be detected by naked eyes, it is called hematuria under the microscope.

After discovering red urine, parents should not panic. First of all, we should distinguish between true hematuria and false hematuria. Some drugs can cause red urine, such as aminopyrine, phenytoin sodium, rifampicin, phenol red and so on. It should be distinguished from true hematuria. There are many reasons for hematuria, including the following;

1, urinary system diseases such as nephritis (acute glomerulonephritis, viral nephritis, hereditary nephritis, allergic purpura nephritis), calculus (kidney, bladder, urethra), cardiorenal tuberculosis, various congenital malformations, injuries, tumors, etc.

2. Systemic diseases such as hemorrhagic diseases, leukemia heart failure, septicemia, vitamin C and K deficiency, hypercalciuria, neonatal symptoms, etc.

3, physical and chemical factors such as food allergies, radiation exposure, drugs, poisons, after exercise. In order to clarify the cause and determine the location of hematuria, three cups of urine test can understand the source of hematuria, and the method is very simple.

Take three cups. In one urine, the first cup takes the pre-urine, the second cup takes the middle urine and the third cup takes the post-urine. If the first cup is hematuria, it means that the blood comes from the urethra; The third cup hematuria is terminal hematuria, and the lesions are mostly in bladder or posterior urethra; The first cup, the second cup and the third cup are bloody, that is, the whole process of hematuria, suggesting that the lesion is in the urinary tract above the kidney or bladder.

It is necessary to know what kind of disease hematuria is caused by, or to carry out various experiences, X-ray, CT examination and even renal biopsy according to symptoms and signs before the diagnosis can be made.

Hematuria and Bladder Tumors Professor Shen Wenjiang

The recently published national cancer survey shows that the incidence and disability rate of bladder cancer have obviously increased, and bladder cancer has become one of the top ten tumors in China. Hematuria is a dangerous signal that cannot be ignored for bladder cancer. There may be many causes of hematuria visible to the naked eye, but more than 90% of them are diseases of urinary organs and urinary tract tumors, such as bladder tumors, kidney tumors, renal pelvis and ureter tumors, urethral tumors and male prostate tumors. , should be thought of first. Gross hematuria means that the discharged urine is bright red or pink, and sometimes there are even small blood clots. Gross hematuria 10%- 15% is a malignant tumor.

With the increase of age, the incidence of gross hematuria in patients with urinary malignant tumor increases. In gross hematuria under 40 years old,110 is a malignant tumor. 50-59 years old, 1/4 is cancer; More than 60-69 years old 1/3 is cancer; Over 70 years old, 70% is cancer. The occurrence of hematuria in middle-aged and elderly people must be paid attention to.

Before the occurrence of hematuria visible to the naked eye, there may be hematuria invisible to the naked eye and visible under the microscope, which can only be found by urine test during physical examination. Gross hematuria is the earliest and most common symptom of bladder cancer. Hematuria has two obvious characteristics. First, it is painless. The patient may have obvious hematuria without any pain. Second, intermittent hematuria, vascular rupture, ulcer and necrosis at the tumor site, causing vascular injury and hematuria, hemostasis after coagulation, and repeated bleeding after destruction. From the first gross hematuria to the second gross hematuria in patients with bladder cancer, many patients have an interval of six months to one year. Treatment with antibiotics and hemostatic drugs can temporarily stop hematuria, but it must not be taken lightly, otherwise it will delay diagnosis and treatment.

The severity of gross hematuria is related to the size, number and malignant degree of bladder tumor, but it is not necessarily proportional, so the severity of gross hematuria can not be used to estimate the disease stage of bladder tumor. Gross hematuria, even if only once, should be examined in detail. Early bladder tumors rarely have symptoms of urinary tract irritation. If the bladder tumor is infected or grows in the lower part of the bladder, there may be urinary tract irritation symptoms such as urgency, frequent urination, micturition pain and dysuria in the early stage.

Most patients with bladder cancer are over 50 years old, 3/4 are male patients, and most of them are smokers. If there is gross hematuria, it is necessary to check whether there are cancer cells in the urine, as well as cystoscopy and urography. If necessary, you can do CT, MRI and B-ultrasound.

How to determine the source of hematuria?

When hematuria is found, we must first determine whether it is true hematuria, that is, to exclude false hematuria and red urine caused by some reasons. The former is bleeding caused by menstruation, hemorrhoid bleeding or diseases near the urethral orifice and mixed with urine; The latter, such as hemoglobinuria or myoglobinuria caused by contact with certain pigments or drugs such as rifampicin, certain poisons (phenol, carbon monoxide, chloroform, snake venom), drugs (sulfanilamide, quinine), crush injury, malaria, transfusion, etc. Transient hematuria can be caused by pollen, chemical substances or drug allergy, and menstrual period, strenuous exercise and virus infection can also occur, which is generally meaningless. Only when all the above conditions are excluded and repeated examinations are hematuria should we pay attention to it and make a diagnosis through medical history, physical examination, laboratory examination and other auxiliary examinations. After the diagnosis of true hematuria, we should make a localized diagnosis of hematuria and distinguish whether hematuria comes from renal parenchyma or urinary tract: ① If casts are found in urine sediment, especially red blood cell casts, it means that bleeding comes from renal parenchyma; ② Hematuria with severe proteinuria is almost always a sign of glomerular hematuria; ③ If a cast containing immunoglobulin can be found in urine, it is mostly renal parenchymal hemorrhage; ④ For hematuria caused by glomerular diseases, most red blood cells are deformed, with different shapes and obvious differences in size, but they are not glomerular hematuria. Most red blood cells are normal in size and a few are deformed red blood cells. The etiology of non-glomerular hematuria is very complicated, and special attention should be paid to malignant tumors of genitourinary system. The principle of symptomatic treatment of two types of hematuria is also opposite. Glomerular hematuria often needs anticoagulation, antithrombosis, antiplatelet aggregation or promoting blood circulation to remove blood stasis, while non-glomerular hematuria often needs hemostasis treatment.