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Hematuria Blood in The Urine 508 PDF
Hematuria Blood in The Urine 508 PDF
What is hematuria?
U.S. Department
of Health and
Human Services
NATIONAL
INSTITUTES
OF HEALTH
Hematuriaisbloodintheurine.Twotypes
ofbloodintheurineexist.Bloodthatcan
beseenintheurineiscalledgrosshematuria.Bloodthatcannotbeseenintheurine,
exceptwhenexaminedwithamicroscope,is
calledmicroscopichematuria.
Kidneys
Bladder
Ureters
Urethra
Theurinarytract
thetwokidneysprocessabout200quarts
ofbloodtoproduceabout1to2quartsof
urine,composedofwastesandextrawater.
Theurineflowsfromthekidneystothe
bladderthroughtubescalledureters.The
bladderstoresurineuntilreleasingitthrough
urination.Whenthebladderempties,urine
flowsoutofthebodythroughatubecalled
theurethraatthebottomofthebladder.
cancerofthekidneyorbladder
afamilyhistoryofkidneydisease
inflammationofthekidney,urethra,
bladder,orprostateawalnut-shaped
glandinmenthatsurroundstheurethra
attheneckofthebladderandsupplies
fluidthatgoesintosemen
anenlargedprostate,whichtypically
occursinmenage50orolder
polycystickidneydiseaseaninherited
disordercharacterizedbymanygrapelikeclustersoffluid-filledcyststhat
makebothkidneyslargerovertime,takingoveranddestroyingworkingkidney
tissue
bloodclots
bloodclottingdisorders,suchas
hemophilia
sicklecelldiseaseaninheriteddisorderinwhichRBCsformanabnormal
crescentshape,resultinginlessoxygen
deliveredtothebodystissues,clogging
ofsmallbloodvessels,anddisruptionof
healthybloodflow
2 Hematuria:BloodintheUrine
urinarystonedisease
certainmedicationsincludingaspirin
andotherpainrelievers,bloodthinners,
andantibiotics
strenuousexercisesuchaslong-distance
running
arecentbacterialorviralinfection
How is hematuria
diagnosed?
Hematuriaisdiagnosedwithurinalysis,
whichistestingofaurinesample.Theurine
sampleiscollectedinaspecialcontainerin
ahealthcareprovidersofficeorcommercial
facilityandcanbetestedinthesamelocationorsenttoalabforanalysis.Forthetest,
anurseortechnicianplacesastripofchemicallytreatedpaper,calledadipstick,intothe
urine.Patchesonthedipstickchangecolor
whenRBCsarepresentinurine.When
bloodisvisibleintheurineoradipsticktest
oftheurineindicatesthepresenceofRBCs,
ahealthcareproviderexaminestheurine
withamicroscopetomakeaninitialdiagnosisofhematuria.Thenextstepistodiagnosethecauseofthehematuria.
Thehealthcareproviderwilltakeathorough
medicalhistory.Ifthehistorysuggestsa
causethatdoesnotrequiretreatment,the
urineshouldbetestedagainafter48hours
forthepresenceofRBCs.Iftwoofthree
urinesamplesshowtoomanyRBCswhen
viewedwithamicroscope,moreserious
causesshouldbeexplored.Thehealthcare
providermayorderoneormoreofthefollowingtests:
Urinalysis.Furthertestingoftheurine
maybedonetocheckforproblemsthat
cancausehematuria,suchasinfection,
kidneydisease,andcancer.ThepresenceofwhitebloodcellssignalsaUTI.
RBCsthataremisshapenorclumped
togethertoformlittletubes,called
casts,mayindicatekidneydisease.
Largeamountsofproteinintheurine,
calledproteinuria,mayalsoindicate
kidneydisease.Theurinecanalsobe
testedforthepresenceofcancercells.
Blood test.Abloodtestinvolvesdrawingbloodatahealthcareproviders
officeorcommercialfacilityandsendingthesampletoalabforanalysis.A
bloodtestcanshowthepresenceofhigh
levelsofcreatinine,awasteproductof
normalmusclebreakdown,whichmay
indicatekidneydisease.
Biopsy.Abiopsyisaprocedurethat
involvestakingapieceofkidneytissue
forexaminationwithamicroscope.The
biopsyisperformedbyahealthcare
providerinahospitalwithlightsedationandlocalanesthetic.Thehealth
careproviderusesimagingtechniques
suchasultrasoundoracomputerized
tomography(CT)scantoguidethe
biopsyneedleintothekidney.The
kidneytissueisexaminedinalabbya
pathologistadoctorwhospecializes
indiagnosingdiseases.Thetesthelps
diagnosethetypeofkidneydisease
causinghematuria.
3 Hematuria:BloodintheUrine
Cystoscopy.Cystoscopyisaprocedure
thatusesatubelikeinstrumenttolook
insidetheurethraandbladder.Cystoscopyisperformedbyahealthcare
providerintheoffice,anoutpatient
facility,orahospitalwithlocalanesthesia.However,insomecases,sedationandregionalorgeneralanesthesia
areneeded.Cystoscopymaybeused
tolookforcancercellsinthebladder,
particularlyifcancercellsarefound
withurinalysis.Formoreinformationaboutcystoscopy,seetheNational
KidneyandUrologicDiseasesInformationClearinghouse(NKUDIC)fact
sheetCystoscopy and Ureteroscopyat
www.urologic.niddk.nih.gov.
Kidney imaging tests.Intravenous
pyelogram(IVP)isanxrayoftheurinarytract.Aspecialdye,calledcontrast
medium,isinjectedintoaveininthe
personsarm,travelsthroughthebody
tothekidneys,andmakesurinevisibleonthexray.Thecontrastmedium
alsoshowsanyblockageintheurinary
tract.Whenasmallmassisfound
withIVP,anotherimagingtest,suchas
anultrasound,CTscan,ormagnetic
resonanceimaging(MRI),canbeused
tofurtherstudythemass.Imagingtests
areperformedinanoutpatientcenter
orhospitalbyaspeciallytrainedtechnician,andtheimagesareinterpreted
byaradiologistadoctorwhospecializesinmedicalimaging.Anesthesia
isnotneeded,thoughlightsedation
maybeusedinsomecases.Imaging
testsmayshowatumor,akidneyor
bladderstone,anenlargedprostate,
orotherblockageofthenormalflow
ofurine.Formoreinformationabout
imagingtestsusedtoexaminethe
urinarytract,seetheNKUDICfact
sheetImaging of the Urinary Tractat
www.urologic.niddk.nih.gov.
Points to Remember
Hematuriaisbloodintheurine.
Mostpeoplewithmicroscopichematuriadonothavesymptoms.Peoplewith
grosshematuriahaveurinethatispink,
red,orcola-coloredduetothepresence
ofredbloodcells(RBCs).
Hematuriacanbecausedbymenstruation,vigorousexercise,sexualactivity,
viralillness,trauma,orinfection,such
asaurinarytractinfection(UTI).More
seriouscausesofhematuriainclude
cancerofthekidneyorbladder
inflammationofthekidney,urethra,
bladder,orprostate
polycystickidneydisease
bloodclots
bloodclottingdisorders,suchas
hemophilia
sicklecelldisease
4 Hematuria:BloodintheUrine
Whenbloodisvisibleintheurineor
adipsticktestoftheurineindicates
thepresenceofRBCs,theurineis
examinedwithamicroscopetomake
aninitialdiagnosisofhematuria.The
nextstepistodiagnosethecauseofthe
hematuria.
Ifathoroughmedicalhistorysuggestsa
causethatdoesnotrequiretreatment,
theurineshouldbetestedagainafter
48hoursforthepresenceofRBCs.If
twoofthreeurinesamplesshowtoo
manyRBCswhenviewedwithamicroscope,moreseriouscausesshouldbe
explored.
Oneormoreofthefollowingtests
maybeordered:urinalysis,bloodtest,
biopsy,cytoscopy,andkidneyimaging
tests.
Hematuriaistreatedbytreatingits
underlyingcause.
Acknowledgments
PublicationsproducedbytheClearinghouse
arecarefullyreviewedbybothNIDDKscientistsandoutsideexperts.Thispublication
wasreviewedbyJeanneCharleston,R.N.,
JohnsHopkinsBloombergSchoolofPublic
Health.
5 Hematuria:BloodintheUrine
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NIHPublicationNo.124559
March2012
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