Contents
Introduction
Haematuria is the passing of blood in the urine
- Frank Haematuria – the presence of blood on macroscopic investigation (i.e. looking at the blood)
- Microscopic Haematuria – RBC’s visible only 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
- BPH – painless, 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