Haematuria, the presence of blood in urine, is a significant clinical finding that can arise from various pathologies in the urinary tract. It’s categorized as either macroscopic (visible) or microscopic (detected on urinalysis).
Causes:
- Infections: Urinary tract infections, prostatitis, or kidney infections (pyelonephritis).
- Stones: Kidney or bladder stones.
- Trauma: To the kidneys, bladder, or other parts of the urinary tract.
- Cancer: Bladder, kidney, or prostate cancer.
- Glomerular Diseases: Like glomerulonephritis.
- Medications: Certain drugs, like anticoagulants and anti-cancer medications, can cause bleeding.
- Benign Prostatic Hyperplasia (BPH): In older men.
- Exercise: Strenuous exercise can sometimes cause transient haematuria.
- Others: Coagulopathies, endometriosis (rarely), and congenital urinary tract anomalies.
Diagnosis:
- History:
- Symptom Evaluation: Assess for pain, dysuria, urgency, frequency, and urine stream changes.
- Recent Infections or Trauma: Inquire about recent UTIs, kidney infections, or any trauma.
- Medical History: Including history of stones, cancer, renal diseases, or use of medications like anticoagulants.
- Family History: Particularly of kidney disease or cancer.
- Lifestyle Factors: Such as smoking, which increases the risk of bladder cancer.
- Physical Examination:
- Blood Pressure Measurement: As hypertension can be related to kidney disease.
- Abdominal Examination: For masses, tenderness, or organomegaly.
- Pelvic Examination in Women: To identify potential gynecological sources.
- Digital Rectal Examination in Men: To assess the prostate.
- Investigations:
- Urinalysis: To confirm haematuria and check for protein, leukocytes, or nitrites.
- Urine Culture: To exclude infection.
- Urine Cytology: For cancer screening.
- Blood Tests: Including renal function tests and full blood count.
- Imaging: Ultrasound of the kidneys and bladder; CT scan if stones or malignancy are suspected.
- Cystoscopy: To visually inspect the bladder and urethra.
Differential Diagnosis (DDx):
- Hemoglobinuria or Myoglobinuria: Due to hemolysis or rhabdomyolysis, respectively.
- Menstrual Contamination: In women.
- Food Coloring: Certain foods or drugs can discolor urine.
- Renal Papillary Necrosis: Especially in diabetics or those with sickle cell disease.
Management:
- Treating the Underlying Cause:
- Infections: Antibiotics for UTIs or kidney infections.
- Stones: Pain management, and intervention to remove or break up large stones.
- Cancer: Referral to urology or oncology for specific treatments.
- Glomerular Disease: Managed by nephrologists with medication and dietary modifications.
- Symptomatic Management:
- Pain Relief: Analgesics for pain associated with stones or infections.
- Bladder Spasms: Antispasmodic medication if needed.
- Follow-Up and Monitoring:
- Repeat Urinalysis: To ensure resolution post-treatment.
- Regular Monitoring: Especially if haematuria was associated with risk factors for cancer or chronic kidney disease.
- Lifestyle Modifications:
- Hydration: Encouraging adequate fluid intake.
- Dietary Changes: Particularly for stone formers.
- Referral:
- Urology: For further evaluation of potential malignancies or complex cases.
- Nephrology: For suspected glomerular disease.
- Patient Education:
- Understanding the Cause: Educating the patient about the specific cause of their haematuria and the importance of follow-up.
It’s important to determine the cause of haematuria promptly, as it can be a symptom of a serious underlying condition. The management strategy will depend on the identified cause and may involve a multidisciplinary approach.