DEFINITIONMore than three red blood cells are found incentrifuged urine per high-power fieldmicroscopy ( > 3 RBC/HP).Normal urine:no red blood cell or less than 3 red blood cell
Classification According to the amount of RBC in the urine, hematuria can be classified as:• gross hematuria (visible) • microscopic hematuria tea-colored, cola-colored, pink or normal colour with eyes even red
ClassificationAnother classification by Timing (when it occursduring urination), which may indicate the location ofthe problem.Initial hematuria: Onset of urination – urethra.Total hematuria: Throughout urination – bladder,ureter, or kidneys.Terminal hematuria: End of urination – bladder orprostate (men).
ETIOLOGY Diseases of the urinary system— the most common causea- Glomerularb- Interstitialc- Uroepitheliumd- Vascular
Diseases of adjacent organs to urinary tract appendicitis carcinoma of the rectum carcinoma of the colon uterocervical cancer Drug and chemical agents anticogulation cyclophosphamide miscellaneous exercise induced hematuria
DIFFERENTIAL DIAGNOSIS• Polluted urine: menstruation• Drug and food: Rifampicin, Nitrofurantoin, sulfonamides, adriamycin.• Porphyria: porphyrin in urine (+)• Hemoglobinuria (hemolysis)• Myoglobinuria
ACCOMPANIED SYMPTOMS• Hematuria with renal colic renal stone, ureteric stone.• Hematuria with urinary frequency,urgency and dysuria bladder or lower urinary tract (TB or tumor) If accompanied by high spiking fever, chill and loin pain: pyelonephritis
ACCOMPANIED SYMPTOMS• Hematuria with edema and hypertension glomerulonephritis - hypertensive nephropathy• Hematuria with mass in the kidney neoplasm - hereditary polycystic kidney• Hematuria with hemorrhage in skin and mucosa hematological disorders - infectious diseases• Hematuria with chyluria filariasis
LABORATORY TESTS Three-glass testMethod: collecting the three stages of urine of a patient during micturitionResult: the initial specimen containing RBC—the urethra. the last specimen containing RBC—the bladder. neck and trianglar area, post. Urethra. all the specimens containing RBC—upper urinary tract, bladder.
LABORATORY TESTSPhase-contrast microscopy to distinguish glomerular from post glomerular bleeding• Post glomerular bleeding: normal size and shape of RBC• Glomerular bleeding: dysmorphic RBC (acanthocyte)
LABORATORY TESTSExample Of Phase-contrast Microscopy Test Non-Glomerular Glomerular (dysmorphic RBCs)
HEMATURIA Algorithm proteinuria (>500mg/24h) (-) Dysmorphic RBC or RBC casts (+) (+)Pyuria,WBC casts urine culture eosinophils (-) serologic and hematologic evaluation: blood culture,Hb electrophoresis, urine cytology, anti-GBM Ab, ANCA,UA of family member, 24h urinary complement, cryoglobulincalcium/uric acid HBV,HCV,VDRL,HIV, (-) As indicated: ASLO (+)IVP+/-renal retrogradeultrasound pyelography or renal biopsy (-) arteriogram of cyst (+) aspirationcystoscopy (-) biopsy ANCA:antineutrophil cytoplasmic (+) antibody, VDRL:venereal dis. CT scan research laboratory, ASLO: (-) open renal biopsy antisteptolysin O, IVP: intravenous follow pyelography