Introduction

Haematuria is the passing of blood in the urine

  • Frank Haematuriais the presence of blood on macroscopic investigation (i.e. looking at the blood)
  • Microscopic Haematuriais where you can only see RBC’s on microscopic investigation
  • Haemoglobinurea is the presence of free haemoglobin in the urine
Haematuria always requires further investigation.
  • Initial haematuria – this is presence of blood in the urine when you first start micturating – this implies urethral damage
  • Terminal haematuria – this is the presence of blood in the urine at the end of the stream, and this suggests a problem with the prostate or bladder base.
  • Ribbon clots suggest a ureteric cause
  • Kidney bleeds can mimic renal colic as the clot passes down the ureter.

Causes

Kidney

  • Trauma – mild to moderate trauma often causes this, but severe trauma may not.
  • Tumours – can produce profuse or intermittent bleeding
  • Renal cell carcinoma there may be loin pain, colic caused by a clot, an associated mass, hypertension, hypercalcemia, erythrocytosis (aka polycythemia –increased number of RBCs)
  • Calculus – sever loin / groin pain, associated infection
  • Glomerulonephritis often associated systemic disease (e.g. SLE)
  • Pyelonephritis – (rare)
  • Renal TB (rare) – may be associated weight loss / anorexia, and sterile pyuria (urine that contains pus)
  • Polycystic disease – (rare)
  • Renal infarction – (rare)
  • TCC – painless, intermittent haematuria

Ureter

  • Calculus – sever loin / groin pain, associated infection

Bladder

  • Calculus – sudden cessation of micturition, pain in perineum and penis
  • TCC – painless, intermittent haematuria, history of work in the rubber / dye industries.
  • Acute cystits – frequency, dysuria (pain / difficulty micturating), bacteriuria
  • Interstitial cystits – a bladder condition of unknown origin, characterised by frequency, urgency and pain. It may be autoimmune, and sometimes caused b y radiation therapy.

Prostate

  • BPHpainless, haematuria, recurrent UTI, associated obstructive symptoms.
  • Carcinoma – rare cause of haematuria

Urethra

  • Trauma
  •  Calculus – rare
  • Urethritis – rare

Investigations

  • FBC – to test for infection, and chronic blood loss
  • Clotting to exclude an underlying bleeding cause
  • U+E – to asses renal function
  • MSU – to check for infection and parasites
  • Csytoscopy – if suspect a bladder cause
  • Autoimmune scan – if suspect glomerulonephritis
  • Intravenous Urography (IVU) / CT scan / ultrasound – if you suspect a renal cause

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