The detection of blood in urine is called hematuria in medical terms. It happens that it is detected only by microscopy of the sediment by the increased number of red blood cells. You should take the situation much more seriously when bright blood comes out in the urine, and traces of clots or streaks remain on the toilet.

These signs are called microhematuria and macrohematuria, respectively. Normally, several red blood cells are allowed per field of view during microscopy of urine sediment. There are also physiological reasons for the appearance of blood in the urine.

To exclude the influence of pathological changes, a study is carried out to determine the difficult detection of red blood cells, but also to clarify the question of which part of the urinary system they belong to. This helps to establish the specific disease and the nature of the lesion.

Pathways for blood to enter urine

Blood and urine (urine) are natural biological fluids of the body. They perform important functions and do not have the ability to mix. The barriers are:

• walls of vessels of different calibers;
• nephron membrane in the glomeruli;
• kidney capsule and muscular layer of the ureters and bladder.

To decide why blood cells appeared in the urine, it is necessary to check the state of the defense mechanisms. There are 5 possible violation options:

1. Destruction of the membrane that provides filtration and retention of red blood cells in the renal glomeruli (nephrons) during the formation primary urine. This process actively occurs in all types of inflammation of the parenchyma (nephritis), and passes from the calyces and pelvis during the severe stage of pyelonephritis.
2. Loss of elasticity of the vascular wall, increase in its permeability. Feeding arteries and the venous network accompany all the urinary organs, through them the material necessary for the functioning of the cells is delivered, and waste waste is carried away. Involvement of the vessel in inflammation leads to tissue loosening and increased permeability. Destruction can be even more pronounced with growing tumors and injuries.
3. General congestion during cardiac decompensation necessarily affects the veins of the pelvic organs and kidneys. Phlebitis and thrombosis increase the pressure inside the veins and promote the release of blood into the urine.
4. Mechanical compression of the urinary organs and blood vessels is possible, for example, by a growing tumor, an enlarged pelvis due to hydronephrosis.
5. Systemic lesions of the capillaries during hemorrhagic diathesis, fevers, and blood diseases cause local destruction of the glomerular filtration mechanisms and increase permeability.

What blood in urine means needs to be determined individually in each case.

Only those obtained by examining correctly collected urine can be considered reliable data.

Causes of microhematuria independent of pathology

An increase in the number of red blood cells in the sediment is possible after urine collection against the background of:

• overheating in a steam bath;
• prolonged exposure to the sun in the heat;
• suffered stress;
• drinking alcoholic beverages, overeating spicy and salty foods.

Blood in the urine after physical activity in the form of microhematuria occurs temporarily and stops after rest. If the urine color remains bloody for a long period, then this already indicates a possible pathology.

In diagnosis, the disappearance of hematuria in the supine position and resumption in the vertical position of the body are important. This distinctive sign indicates kidney prolapse (nephroptosis) and its pathological mobility.

The importance of blood getting into the urine with spotting in women from the genitals should be especially emphasized:

• during menstruation;
• from the eroded surface of the cervix;
• with fibromatous changes with uterine bleeding;
• in the postpartum period.

In men, blood in a urine test is often associated with prostatitis, prostate adenoma.

When is there an erroneous suspicion of hematuria?

Some patients are alarmed by the reddish tint of urine. They mistake it for obligatory blood impurities. However, this symptom must be distinguished from the effect of food dyes on the color of urine.

The brightest color is obtained after eating beets, carrots, and blueberries.

The influence of such drugs as vitamin B 12, ascorbic acid, Analgin has been proven.

Decoding the analysis, comparing the number of red blood cells with other elements of urine sediment (leukocytes, protein, casts, bacteria, mucus, salts) makes it possible to find out the specific causes of blood in the urine.

What pathological changes cause hematuria?

Pathology includes the proven presence of blood in the urine. It is impossible to make a correct diagnosis based on one symptom. Collecting anamnesis, checking other clinical signs, and examination results help to find out the true causes and prescribe optimal treatment.

Among diseases of the urinary organs, hematuria is possible with:

• acute and chronic forms of glomerulonephritis;
• severe form of cystitis;
• urolithiasis;
• hydronephrosis;
• kidney tuberculosis;
• tumors of the kidney and bladder.

Less commonly, the symptom is observed with urethritis and pyelonephritis.

IN in this case When blood ruptures, it spreads more to the perinephric tissue; it is not in the pelvis, which means there will be no hematuria

Traumatic injuries to the pelvis and abdomen:

• blows;
• bruises;
• gap;
• compression.

They are accompanied by microhematuria to severe bleeding during urination due to rupture. In surgical medical institutions, trauma is considered to be the consequences of installation of a catheter in the urethral canal; blood in the urine appears as a result of a violation of the integrity of the mucous membrane and small vessels.

The procedure leads to similar consequences.

Blood in the urine after surgery requires the attending physician to clarify the degree of influence of the volume of surgical intervention on the urinary organs.

1. When removing a kidney or partial resection, a temporary thin tube is left in the cavity of the pelvis, through which urine and blood flow out. Through it, the diseased kidney is washed and medications are administered.
2. If the operation was not performed on the urinary organs, then blood in the urine means complications for the patient.

A professional injury to equestrians is considered to be damage to the perineum and urethral bulb with subsequent hematuria.

Poisoning with toxic substances is accompanied by a block of renal filtration, the inability to urinate independently, and the release of coagulated blood from the urethra.

Fever in any disease, as well as infectious hemorrhagic lesions of the renal capillaries are observed:

• in case of toxic damage by breakdown products of protein and bacteria;
• hemorrhagic capillary toxicosis.

In cases of cardiac decompensation due to heart defects, hypertension, or previous myocardial infarction, the main role is played by venous congestion and increased pressure in the renal vein system.

Blood diseases with reduced coagulability (thrombocytopenia, hemophilia) are accompanied by impaired renal function and end-stage hematuria, as well as the intake of fibrin, which forms blood clots in the urine.

Red blood cells may appear in the patient’s urine when trying to treat him with sulfonamide drugs, methenamine, high doses of vitamin C, or an overdose of anticoagulants. These drugs have toxic effects on the kidneys in sensitive people. Patients should be warned to monitor their urine if such medications are prescribed.

What symptoms accompany hematuria?

The most difficult to diagnose is asymptomatic macrohematuria. It occurs suddenly, the patient does not feel pain, but notices a clear admixture of blood in the urine. In such cases, a tumor of the kidney or bladder is suspected. This disease, unfortunately, proceeds secretly for a long time.

When visiting a doctor, you need to quickly do not only a blood and urine test, but also conduct all kinds of examinations. The health and life of the patient depends on the timely start of treatment. If the patient complains that it “pains to write” and blood clots are found in the urine, then a suspicion arises of damage to the bladder as the source of bleeding.

Clots can form due to inflammation (cystitis) with ulceration of the cervical area, a large stone or tumor

Sometimes the clots look like “worms”. They form in the ureters or pelvis. Blood comes from the kidney parenchyma. Often such bleeding is preceded by an attack of renal colic due to the movement of a stone in the pelvis or ureter.

You cannot decipher the analysis data yourself. In diagnosis, the doctor takes into account such manifestations as:

• pain when urinating;
• increased urge;
• urinary retention;
• pain in the lower back and stomach;
• night urination;
• increased body temperature;
• hypertension.

These symptoms confirm or deny the opinion about the pathology of the urinary organs.

Read more about the symptoms of blood in the urine in children.

From what conditions should true hematuria be distinguished?

In differential diagnosis, urologists are faced with the need to distinguish true hematuria from similar conditions. These include:

• urethrorrhagia - this is the name for the spontaneous flow of blood in drops from the urethral opening without the act of urination; it occurs as a complication of the procedure of cystoscopy, catheterization of the bladder, bougienage;
• myoglobinuria is one of the manifestations of long-term crush syndrome, muscle myoglobin builds up in the blood during massive destruction of muscle tissue, causing blockage of renal filtration, therefore, red urine is detected in victims of building rubble or terrorist attacks; such patients require urgent hemodialysis.

When red blood cells are destroyed (the hemolyzing effect of toxic substances, hemolytic crises), hemoglobin is released into the blood, but the red blood cells themselves are not present in the urine sediment. The color of the urine becomes very dark. Observed in the background:

• state of shock from transfusion of blood incompatible by group and rhesus;
• 3rd-4th degree burns;
• hemolytic anemia;
• severe stage of typhus, diphtheria, scarlet fever.

Is it possible to carry out diagnostics using express methods?
It is possible to understand the condition of a person who sees his blood in his urine. Waiting for test results is difficult. There are proposed methods for express analysis using special test strips. The instructions require that the strip be immersed in a container of urine, then dried and assessed against a standard color calibration scale for the presence of hematuria.

In the practice of urologists, this test is not considered sensitive enough:

• cannot accurately detect microhematuria;
• does not allow to distinguish hematuria from hemoglobinuria.

Therefore, it is not recommended to carry out tests on your own at home. It is better to collect urine in accordance with the rules and get a fairly informative conclusion.

What is the definition of the type of red blood cells?

Identification alone is not enough to answer the question about the source of bleeding and the level of damage to the urinary tract. To do this, the laboratory technician must determine the type of change in erythrocyte cells.

By microscopy of urine sediment, 2 types of red blood cells are identified:

1. Unchanged - they look like round cells with a concave middle, are saturated with hemoglobin, and have a reddish tint (similar cells are present in the blood). Come from the kidneys or bladder in the absence of any urinary retention.
2. Changed or leached - formed in case of prolonged presence in urine, look wrinkled and ring-shaped, lose hemoglobin. Similar changes are possible with kidney stones, a tumor obstructing the ureter or bladder neck, abnormalities of the ureters and kidneys, and hydronephrosis.

Microscopy of urine sediment is carried out in the laboratory

A variant of the norm is considered to be leached red blood cells in the urine of people with a predominant meat diet. Limiting vegetables and fruits leads to a lack of alkaline reserve in the body. To maintain the balance, alkalis are “extracted” from your own cells.

Detection of an impurity in the urine that resembles blood should alert the patient and lead to an awareness of the need for a full examination. It should be borne in mind that laboratory analysis is not considered by doctors as the main sign of a particular disease.

The composition of urine can indicate the presence of certain diseases. internal organs. Thus, red blood cells, white blood cells, protein, etc. are sometimes found in urine. Depending on the composition of urine, conclusions are drawn about the presence of inflammatory processes and other organ pathologies in the body.

If blood is found in the urine, this phenomenon is called hematuria. But blood in urine is not always visible to the naked eye. Sometimes it is detected by microscopic examination of the sediment, and in some cases it requires the use of a special reagent. We will tell you what a reaction to blood in the urine means, how this study is carried out, and how the results are interpreted.

Diagnosis and identification of the cause of hematuria

Hematuria – dangerous symptom, which accompanies many pathologies. For example, in men, such a reaction of the body is observed with prostatitis, adenoma and various pathologies of the genitourinary system. In order to diagnose and identify the causes of this condition, the following studies are carried out:

• OAM (general urine analysis);
• CBC (general blood test);
• biochemical blood test to determine coagulability;
• culture of urine to identify infectious agents;
• Ultrasound of the genitourinary system;
• urine test according to Nechiporenko;
• intravenous urography;
• study of red blood cells;
• examination by a urologist (only for men);
• cystoscopy;
• examination by a proctologist;

A three-glass urine test is also required. To do this, three portions of urine are collected in different containers - at the beginning of the stream, in the middle and at the end of urination. These body fluid samples are examined for the presence of red blood cells, pus, mucus, blood, and white blood cells.

After a three-glass urine test and a reaction to the blood are done, the results are interpreted:

1. If, after a urine test, the reaction to blood is positive only in the first urine sample (and negative in the second and third), then this indicates pathologies of the urethra.
2. If the result is positive in the second and third samples, they indicate damage to the neck of the bladder.
3. If a positive result is present in all three samples, then this indicates oncology of the prostate gland, urinary tract or kidney tumors.

How is a urine test for hematuria performed?

Urine testing for hematuria is carried out using one of the following methods:

1. If used visual assessment of urine color, then the method is called organoleptic. However, its accuracy is questionable because the color of urinary fluid often changes depending on the foods eaten or medications used. That is why, when its reddish color occurs, more precise methods research.
2. Using a special rapid test. It uses a special reagent that, when interacting with hemoglobin in the blood, changes color. To carry out the study, test strips are used that are impregnated with a reagent. If the result is weakly positive, the urine is additionally examined under a microscope to confirm or refute it.

Important! A test strip analysis can be not only weakly positive, positive, negative, but also false positive, so it often needs to be clarified using traditional microscopic examination.

What is a reaction to blood in urine?

The reaction to the presence of blood elements in urine is a special test that allows you to identify hidden blood in this physiological fluid. It is based on the pseudoperoxidase effect of human hemoglobin. When this blood component comes into contact with organic stabilized hydroperoxide, the oxidation of the chromogen is catalyzed.

Although these tests are very sensitive, they do not respond to the physiological natural levels of red blood cells and hemoglobin in urine. A weakly positive reaction to blood in the urine is observed even with a concentration of erythrocytes in the amount of 3-5 pieces in 1 μl of physiological fluid. If there are 5-10 red blood cells in the same portion of urine, small light green dots appear on the test zone.

The sensitivity of the test for intact red blood cells is much lower. That is why, if the reaction to blood in the urine is positive, the test must be repeated several times, and the patient must be referred for further examination.

Decoding the analysis results

The results are interpreted by a doctor. Normally, in any healthy person (provided that he is at rest), blood is not detected in the urine:

• hemoglobin should not be detected in urine sediment of normal color;
• per microliter in men, the presence of 1-2 red blood cells in the field of view is allowed, in women - no more than three.

Any deviations from the norm to a greater extent indicate the presence of a particular disease and are a reason for a more detailed examination of the patient.

General analysis urine is a set of various diagnostic tests aimed at determining the general properties of urine, as well as its physicochemical and microscopic examination. In this case, indicators such as color, smell, transparency, reaction (pH), density, protein, glucose content in urine, ketone bodies, bilirubin and its metabolic products. The presence of cellular elements, as well as salts and casts, is determined in the urine sediment.

Synonyms Russian

Clinical urine analysis, OAM.

English synonyms

Complete Urinalysis.

Research method

"Dry chemistry" method + microscopy.

Units

Cells/μl (cells per microliter).

What biomaterial can be used for research?

The average portion of morning urine, the first portion of morning urine, the third portion of morning urine.

How to properly prepare for research?

• Avoid taking diuretics for 48 hours before urine collection (in consultation with your doctor).
• Women are advised to donate urine before menstruation or 2-3 days after it ends.

General information about the study

Urine is the end product of the kidneys, which is one of the main components of metabolism and reflects the state of the blood and metabolism. It contains water, metabolic products, microelements, hormones, desquamated cells of the tubules and mucous membrane of the urinary tract, leukocytes, salts, and mucus. The combination of physical and chemical parameters of urine, as well as analysis of the content of various metabolic products in it, makes it possible to assess not only the function of the kidneys and urinary tract, but also the state of certain metabolic processes, as well as identify disturbances in the functioning of internal organs. This information can be obtained by deciphering a general urine test.

Microscopy of urine sediment is a qualitative and quantitative determination of a number of insoluble compounds (organic and inorganic) in urine. The indicators available for study allow you to get Additional information concerning metabolism, as well as infectious and inflammatory processes.

The dry chemistry method is based on the effect of changing the color of the reaction zone of the test strip as a result of the reaction of the dye present in the reaction zone with urine protein molecules. The reaction zone is a porous strip soaked in a reagent solution and dried. The reagents include substances that stabilize the pH (buffer) and a dye. When the reaction zone is saturated with urine, the dry components dissolve and react with the components of the urine. If there is no protein in the urine, the reaction zone remains colorless or slightly yellowish, since the dye molecules absorb light in the blue region of the spectrum. If the urine sample with which the reaction zone is impregnated contains protein molecules, then the dye molecules form complexes with the latter and their absorption spectrum shifts to the red side, which allows the reaction to be assessed and a report to be compiled on the analyzed indicators.

It must be remembered that the results of a general urine test can be correctly interpreted and their compliance with standards assessed only by the attending physician, taking into account clinical and laboratory data, objective examination data and the conclusions of instrumental studies.

What is the research used for?

• For a comprehensive examination of the body.
• For the diagnosis and differential diagnosis of kidney and urinary tract diseases.
• In order to evaluate the effectiveness of treatment of diseases of the urinary organs.
• For the diagnosis of metabolic diseases, water and electrolyte imbalances.
• For the diagnosis of diseases of the gastrointestinal tract.
• For the diagnosis of infectious and inflammatory diseases.
• To assess and monitor the patient’s clinical condition during surgical and/or therapeutic treatment.

When is the study scheduled?

• With a comprehensive examination and monitoring of patients of various profiles.
• During a preventive examination.
• For symptoms of a disease of the urinary system (changes in the color and odor of urine, frequent or rare urination, an increase or decrease in the daily volume of urine, pain in the lower abdomen, pain in the lumbar region, fever, swelling).
• During and after the course of treatment for pathologies of the kidneys and urinary tract.
• While taking nephrotoxic drugs.

What do the results mean?

Interpretation of a general urine test:

Reference values ​​(normal indicators)

Color: from straw yellow to yellow.

Transparency: transparent.

Protein: not detected or less than 0.1 g/l.

Glucose: not detected.

Bilirubin: not detected.

Urobilinogen: not detected or traces.

Ketone bodies: not detected.

Nitrites: not detected.

Reaction to blood: not detected.

Specific gravity: 1.003 - 1.030.

Reaction: 5.0 - 7.5.

Leukocytes: none or traces detected.

Urine sediment examination

• Bacteria: not detected or a small amount.

• Epithelium is flat

• Leukocytes

• Red blood cells: 0 - 11 cells/µl.
• Cylinders: not detected.
• Mucus: small amount.
• Crystals (oxalates): none.

Color

The color of urine normally ranges from straw to deep yellow. It is determined by the presence of coloring substances in it - urochromes, the concentration of which mainly determines the color intensity. Saturated yellow usually indicates relative high density and urine concentration. Colorless or pale urine has low density and is excreted in large quantities.

Changes in urine color are sometimes associated with a number of pathological conditions. Dark color may indicate the presence of bilirubin or high concentrations of urobilinogen. Various shades of red may appear when blood is passed through the urine. Some medications and foods also make your urine appear different shades of red and yellow. The whitish color of urine may be due to the admixture of pus, the precipitation of salts, the presence of leukocytes, cells and mucus. Blue-green shades of urine may be a consequence of increased decay processes in the intestines, which is accompanied by the formation, absorption into the blood and release of specific coloring substances.

Reaction

The acid-base reaction (pH), like some other indicators of general urine analysis, depends on food and certain metabolic processes. Animal foods cause acidification of urine (pH less than 5), while dairy and vegetable foods contribute to its alkalization (pH more than 7). The kidneys can also affect the acidity of urine.

In addition, acidification of urine is caused by a violation of the salt balance of the blood (hypokalemia) and certain diseases (diabetes mellitus, gout, fever, etc.).

Excessive alkaline urine reaction can occur with inflammatory/infectious diseases of the kidneys and urinary tract, massive loss of salts (due to vomiting, diarrhea), impaired renal regulation of urine acidity or blood impurities in it.

Specific gravity

Urine specific gravity (relative density) reflects the ability of the kidneys to concentrate and dilute urine. It depends significantly on the volume of fluid consumed.

The specific gravity of urine exceeds the norm, for example, when blood filtration through the kidneys deteriorates (kidney disease, weakened heart function), large fluid losses (diarrhea, vomiting) and accumulation of soluble impurities in the urine (glucose, protein, drugs, as well as their metabolites). It may decrease due to certain kidney diseases and disturbances in hormonal regulation of the process of urine concentration.

Transparency

Normally, urine should be clear. It can become cloudy due to the admixture of red blood cells, leukocytes, epithelial cells of the urinary tract, fat droplets, acidity and precipitation of salts (urates, phosphates, oxalates). During long-term storage, urine sometimes becomes cloudy due to bacterial growth. Normally, slight turbidity is due to the presence of epithelium and mucus.

Color

Color urine normally ranges from straw to deep yellow and depends on the content of urochromes. A deep yellow color usually indicates relatively high density and concentrated urine. Colorless or pale urine has low density and is excreted in large quantities. A dark color may indicate the presence of bilirubin or a high concentration of urobilinogen. Various shades of red appear when blood is excreted in the urine. Some medications and foods also make your urine appear different shades of red and yellow. The whitish color of urine is due to the admixture of pus, the precipitation of salts, the presence of leukocytes, cells and mucus. Blue-green shades are the result of increased decay processes in the intestines, which is accompanied by the formation of specific coloring substances, their absorption into the blood and release.

Protein

Causes of proteinuria:

• Violation of the filtration barrier - loss of albumin (glomerulonephritis, nephrotic syndrome, amyloidosis, malignant hypertension, lupus nephritis, diabetes mellitus, polycystic kidney disease)
• Decreased reabsorption - loss of globulins (acute interstitial nephritis, acute renal necrosis, Fanconi syndrome)
• Increased production of filterable proteins (multiple myeloma, myoglobinuria)
• Isolated proteinuria without renal dysfunction (due to fever, physical exercise, prolonged standing, congestive heart failure or idiopathic causes)

Bilirubin appears in the urine in case of liver pathology, obstruction of the biliary tract.

Urobilinogen turns urine yellow.

Reasons for the increase:

• hemolytic anemia,
• enteritis,
• liver dysfunction.

Reasons for the downgrade:

• decreased liver function (decreased bile production),
• obstructive jaundice,
• intestinal dysbiosis.

Nitrites

Reasons for the increase: the presence of bacteria in the urine.

Glucose

Reasons for the increase:

• Diabetes mellitus, gestational diabetes
• Other endocrine disorders (thyrotoxicosis, Cushing's syndrome, acromegaly)
• Impaired tubular reabsorption in the kidneys (Fanconi syndrome)

Ketone bodies normally absent in urine. They increase in diabetes mellitus and indicate a deterioration in the patient’s condition. They may appear in the urine during fasting, severe restriction of carbohydrate intake, or prolonged rises in temperature (fever).

Reaction to blood. Normally, urine does not contain blood or its breakdown products (hemoglobin). Formed elements of blood (erythrocytes, leukocytes, etc.) can enter it from the vascular bed through the kidney filter (for example, in case of blood diseases or toxic conditions accompanied by hemolysis) and during the filtration of red blood cells from the blood (in case of kidney disease or bleeding from the urinary organs ).

Flat epithelium Normally occurs in the form of single cells. An increase in their number indicates an inflammatory process of the urinary tract.

Red blood cells are normally present in urine in small quantities.

Causes of hematuria:

• Subacute infective endocarditis
• Benign familial hematuria, benign recurrent hematuria
• Kidney tuberculosis
• Trauma, damage to the urethra by a urinary catheter
• Renal vein thrombosis
• Vasculitis
• Kidney infarction
• Polycystic kidney disease
• Infection (cystitis, urethritis, prostatitis)
• Neoplasms (kidney cancer, prostate cancer, bladder cancer)
• Urolithiasis, or crystalluria
• Systemic lupus erythematosus, lupus nephritis
• Glomerulonephritis

Leukocytes found in small quantities in the urine of a healthy person.

Causes of leukocyturia:

• Fever
• Kidney tuberculosis
• Glomerulonephritis
• Interstitial nephritis, pyelonephritis
• Urinary tract infection

Cylinders(indicate dysfunction of the glomerulus and tubules). A highly sensitive method used in urinalysis can detect a minimal number of casts in the urine of a healthy person.

Reasons for the appearance of casts in urine:

• Kidney infarction
• Glomerulonephritis
• Nephrotic syndrome and proteinuria
• Tubulointerstitial nephritis, pyelonephritis
• Chronic renal failure
• Congestive heart failure
• Diabetic nephropathy
• Malignant hypertension
• Fever with dehydration, overheating
• Intense physical activity, emotional stress
• Heavy metal poisoning
• Kidney amyloidosis
• Kidney tuberculosis
• Kidney transplant rejection
• Lipoid nephrosis
• Paraproteinuria in myeloma

Slime secreted by the cells lining the inner surface of the urinary tract and performs a protective function, preventing chemical or mechanical damage to the epithelium. Normally, its concentration in urine is insignificant, but during inflammatory processes it increases.

Crystals appear depending on the colloidal composition of urine, pH and other properties, may indicate disorders of mineral metabolism, the presence of stones or an increased risk of developing urolithiasis, nephrolithiasis.

Bacteria point to bacterial infection urinary tract.

What can influence the result?

Failure to comply with the rules for submitting material (for example, failure to hygiene procedures, testing during menstruation).

• Diagnosis of autoimmune kidney damage
• Antibodies to glomerular basement membrane

Who orders the study?

General practitioner, therapist, pediatrician, urologist, nephrologist, gastroenterologist, cardiologist, neurologist, surgeon, obstetrician-gynecologist, endocrinologist, infectious disease specialist.

Literature

• Morozova V. T., Mironova I. I., Martishevskaya R. L. Urine examination. – M.: RMAPO. – 1996, – 84 p.
• Fischbach F.T., Dunning M.B. A Manual of Laboratory and Diagnostic Tests, 8th Ed. Lippincott Williams & Wilkins, 2008: 1344 p.
• Hauss O. Bringing Urinalysis into the 21st Century: From Uroscopy to Automated Flow Cytometry. Sysmex Journal International Vol. 18 No.2 (2008).
• Wilson D. McGraw-Hill Manual of Laboratory and Diagnostic Tests 1st Ed. Normal, Illinois, 2007: 666 p.

A general urinalysis with sediment microscopy, among other indicators, allows you to detect whether and in what quantity there are red blood cells in the child’s urine. These blood cells ensure cell respiration. They contain a special protein - hemoglobin, due to which they have a red color.

Because enough big size red blood cells are not able to penetrate the kidney filters. The detection of blood elements, proteins, and excess salts in urine is always alarming, especially when it comes to the health of children.

Types of red blood cells

U healthy child In urine, red blood cells are usually not found at all. If the analysis reveals that the indicators are elevated, this is a reason to contact a specialist to establish the causes and conduct a proper examination. If a child has blood in his urine that is visible to the naked eye, this may indicate a serious pathology of the internal organs. This situation requires urgent consultation with a doctor.

Not last value In the differential diagnosis, it depends on which red blood cells were found in the child’s urine. According to their properties, they are divided into two types:

• Changed (acanthocytes) - without hemoglobin, colorless upon microscopic examination, resembling a ring in shape. They are also called leached.
• Unchanged - contain hemoglobin, biconcave round shape and red color.

The presence of blood in the urine is called hematuria. Based on the level of detected red blood cells, microhematuria is distinguished (urine is not colored, red blood cells are determined only using a microscope) and macrohematuria (with the naked eye you can see red or brown urine, which may have streaks of blood or clots).

There is a concept of false hematuria, when the urine has a red tint, but the cause of this was not bleeding. This condition may occur as a result of the use of certain medicines(analgin, vitamin B12, aspirin), food dyes, as well as products that contain coloring pigments, for example, berries or vegetables (carrots, beets). The girl has adolescence Over 10 years of age, the presence of red blood cells in a urine sample may be due to mixing with menstrual fluid.

If high level erythrocytes is a consequence of injury to the mucous membrane of the kidneys and ureters with stones or salts, then the detected bodies are called fresh, since they were present in the urine for only a short time. Gross hematuria often manifests itself as a one-time reaction of the body to various unfavorable factors. But if after this microhematuria persists for several weeks or a month, a mandatory examination of the child is carried out.

Causes of hematuria

How and why can red blood cells get into the urine if they are in the vascular bed of our body and are large in size? Most often this occurs in conditions where vascular permeability increases, for example, during infectious lesions or inflammation of the kidneys (cystitis, urethritis, nephritis, nephropathy), with microtraumas and injuries of the genitourinary tract, and oncological processes. In any case, the detection of blood in a child’s urine should alert parents.

Hematuria can be observed against the background of protracted or acute infectious diseases caused by viruses or bacteria (ARVI, influenza, tonsillitis, meningococcal damage). In addition, the appearance of blood impurities in urine may indicate a violation of the child’s normal diet (excess proteins, citrus fruits), stress, hypothermia, or too intense physical activity in adolescents.

Please note that taking certain medications can also affect this indicator. Seeing a drop of blood on a diaper infant, it is worth remembering that the blood vessels in children of this age are very fragile and the cause of hematuria can be any problem in the body. In infants, hematuria can result from birth trauma, urinary tract infection, or increased urate content in the urine.

Symptoms of hematuria in children

Bleeding can occur in any part of the urinary tract and can vary in intensity. When blood is released at the initial stage of urination, the process is accompanied by pain, burning, then most likely the bladder or urethra suffers (urethritis, cystitis). In such cases, in addition to red blood cells, leukocytes and mucus will also be present in the microscopy of the urinary fluid sample. The child may have an increase in body temperature up to 38 degrees.

If treatment is not started on time, then due to anatomical features child's body, bacteria can quickly penetrate the upper parts of the urinary system, thereby provoking more serious diseases of the kidneys and ureters (glomerulonephritis, pyelonephritis). This poses a particular danger to newborns, infants and children under 3 years of age. If this happens, the child usually has heat, sometimes up to 39 °C.

With glomerulonephritis, gross hematuria is observed, and edema may appear. The urine sample will contain protein and may cause blood clots. The child is bothered by headaches and weakness. This infectious-allergic disease subsequently develops into autoimmune damage to the renal glomeruli. With pyelonephritis, microhematuria is possible; many bacteria, leukocytes, and columnar epithelium will be found in the sample. The baby complains of pain during urination, lower abdomen, and weakness. Asymptomatic hematuria occurs in the presence of tumors, essential disease, or urolithiasis.

Red blood cell norm and diagnosis

The number of red blood cells in the urine is determined by sediment microscopy. The “manual” method of counting red blood cells gives a more accurate result compared to automatic counting using a machine. The rate of red blood cells in a child’s urine (may be indicated as “bld” on the result form) varies depending on the gender and how old he is. In the urine of a newborn in the first week of life, the value should not exceed 7 units. A one-year-old baby is allowed up to 5 cells in the visual field. In children aged 2 years and older, an indicator of up to 4 is considered normal. The laboratory report may indicate “single red blood cells in the field of view.” In girls, their number is normally slightly higher (up to 3 units) compared to boys (1 in the middle class).

Even if 4-9 units are determined. in p/zr (considered a weakly positive reaction), parents should not ignore this. Detection of up to 20 cells in a sample is considered microhematuria. Urine does not change color. If there are more than 20 red blood cells, this is already considered gross hematuria. The color of the urine becomes red or pink.

If red blood cells are elevated, attention is paid to other indicators of urine sediment. These may be traces of protein, casts, renal epithelium, leukocytes and bacteria. An increase in crystalline salts indicates that you need to look for stones in the urinary system. As a rule, pediatricians recommend additional examination regardless of how elevated the red blood cell count is in a young patient. In addition to the fact that it will be necessary to do OAM again, the doctor will prescribe:

• Ultrasound of the genitourinary tract;
• clinical blood test with determination of leukocyte formula and ESR;
• blood biochemistry;
• study according to Nechiporenko;
• a three-glass urine sample (allows you to determine in which portion blood is found and, therefore, help diagnose the cause).

The pediatrician may prescribe invasive diagnostic methods (cystoscopy, biopsy), MRI and urography. If hematuria is caused by changes in diet or deposits of salts and stones, the doctor will recommend a diet and advise you to increase the amount of fluid you drink.

How should the sample be collected?

For an objective result of the study, it is necessary to follow the rules for collecting urine. The sample should be collected in the morning in a sterile container after hygiene of the child’s genitals. It is preferable to take a medium portion of liquid. After collection, it is advisable to immediately take the container to the laboratory. If this is not possible, then it should be stored in the refrigerator for some time. It is better to collect biomaterial from a child under one year of age using a special urine collector. However, errors in such analysis cannot be excluded. On the eve of collecting the sample, you should not include foods containing large amounts of coloring pigments in your baby’s diet.

Positive dynamics in hematuria are usually observed immediately after the cause is eliminated. Parents need to remember that self-diagnosis and treatment of children if red blood cells are detected in a urine test is prohibited. Hematuria is not a diagnosis, but a symptom of disorders in the body. Treatment is prescribed by a pediatric urologist or nephrologist based on examination and examination of the child and medical history. Medications for children are selected carefully, taking into account possible intolerance or allergies to components.

In professional language it is called hematuria. If there is blood in the urine, its color changes due to the presence of red blood cells in the blood.
Depending on the amount of blood, hematuria is divided into macrohematuria and microhematuria. In the first case, there is so much blood that it can be seen with the naked eye. In the second case, the amount of blood is negligible and it is detected only during laboratory testing or with the help of special disposable tests - strips.
According to the symptoms, hematuria can be painful or painless. And by origin, glomerular or post-glomerular.
In any case, the presence of blood in a urine sample is not normal.

Number doesn't mean anything

Any amount of blood in the urine can indicate very serious illness. Therefore, even if microscopic blood impurities are detected, a complete examination of the body is necessary. Moreover, the older a person is, the more likely it is to have serious illnesses.

Causes of blood in urine

Blood can enter the urine from organs in the path of urine, that is, from the kidneys, ureters, bladder or urethra. There are more than one and a half hundred various reasons this phenomenon.

Most common reasons hematuria:

• Infectious diseases,
• Neoplasms,
• Conglomerates.

Less common causes of blood in urine:
1. Congenital anomalies: cysts or polycystic kidney disease.
2. Diseases that impair blood clotting: leukemia, hemophilia, sickle cell anemia, as well as taking drugs that impair blood clotting.
3. Vascular diseases: renal vein thrombosis, the presence of a blood clot in the renal vessels.
4. Other kidney diseases:

• Pyelonephritis. With this disease, the patient may not experience pain, but this is rare. Usually the first signs of pyelonephritis are chills, pain in the lower back,
• Glomerulonephritis. With glomerulonephritis, a microscopic amount of blood is released, which can only be detected in the laboratory. The disease can pass completely without any signs, symptoms of renal failure may be observed,
• Papillary necrosis. This disease is typical for patients with diabetes mellitus, with impaired oxygenation. The disease is treatable.

Infections

This is primarily tuberculosis of the kidneys or bladder, as well as purulent processes provoked by pyogenic microorganisms, cystitis, urethritis.

After injury

Blood in the urine after injury can occur if the kidney is ruptured. Trauma can be either blunt or penetrating.
The bladder can also be injured. For example, when running for a long time with an empty bladder, its walls can rub each other. After such a run, there may well be a slight presence of blood in the urine.
Such a patient should be examined immediately. Already during his examination and questioning, the doctor may suspect the source of the blood discharge. If the injury to the abdomen or pelvic area was very severe, and also if there was no urination after the injury, the doctor may suspect a rupture of the urinary organs.
If the perineum was injured in the “sitting on a horse” position, there is a possibility of injury to the urethral bulb.
If there is pain above the pubis, and the pain spreads throughout the abdomen, if the patient is nauseous, a ruptured bladder can be suspected.
If the upper abdomen hurts, there is a possibility of severe kidney injury.

For kidney or bladder stones

The most common cause of blood in the urine is urolithiasis. Salt crystals collect in the papillae of the kidneys, which subsequently “attract” more and more deposits to themselves.
Most often, the patient is not aware of the presence of kidney stones, but when laboratory research blood can be detected. Stones create favorable conditions for the development of infection, and also irritate the mucous membrane of the kidneys and ureters. Only very large stones block the ureters and cause acute pain called colic.

You can verify the presence or absence of stones in the urinary tract using excretory urography.

With urethral cancer, blood is observed not only in a urine test, but it can also be detected in the interval between urinations at the outer end of the urethra.

If the blood clots have the shape of worms, this is highly likely to indicate kidney cancer.

Not only malignant neoplasms lead to the appearance of blood in a urine test. Benign tumors can also cause it. However, they are very rare in the urinary organs. Most often these are kidney cysts.

Angiomyolipoma - This benign neoplasm, more often found in women during pregnancy. Its volumes can be very large, and in this case it can manifest itself as the presence of blood in the urine. The entire tissue of angiomyolipoma is riddled with blood vessels and fat cells. The vessels often burst spontaneously, and blood enters the urine. This type of tumor can only be treated with surgery. It is removed without damaging healthy tissue.

Among women

The most common cause of blood in the urine in women is inflammatory processes in the urinary system. With such processes, blood circulation changes, infection leads to the fact that red blood cells penetrate the body tissues.

Very often the presence of hematuria is explained cystitis . During urination, a woman experiences acute pain, cutting or burning. The anatomical structure of the pelvic organs in women is such that favorable conditions are created for infection of the urinary organs. The short urethra makes it easy for infections to enter the bladder.
If hematuria is observed during menstruation, this indicates the presence of endometriosis of the bladder.

Pregnant women often have blood in their urine. But until now, not a single doctor can really explain what is the reason for this phenomenon. One explanation says that during fetal development, the uterus increases in size, compresses nearby urinary organs and causes microscopic injuries. They are absolutely harmless to the health of both mother and fetus. However, if blood is found in the urine during pregnancy, you should definitely visit a doctor as soon as possible.

The reasons for the appearance of blood in the urine of women can be diseases characteristic of both sexes, for example, urolithiasis, cysts, pyelonephritis, small cell anemia, kidney cancer, as well as completely physiological reasons. For example, during the collection of a urine test, menstrual blood got into it.
Sometimes when taking hormonal hormones birth control pills Some blood is found in the urine. This is due to the fact that the hormones contained in the tablets disrupt the condition of the walls of blood vessels in the urinary organs. Tissue trophism worsens, inflammation develops, which sometimes cannot be detected visually.

In men

The reason for the presence of blood in the urine of representatives of the stronger sex may be a disease of the prostate gland, which is usually not malignant.

With prostate adenoma or benign hyperplasia, there is a low probability of blood appearing in the urine. But more often this happens when adenoma and cystitis are combined in an acute form.

The disease is diagnosed by determining the level of urine outflow and the amount of residual urine in the bladder. Treatment is carried out promptly.
Very often, in men, blood is found in a urine sample after heavy physical exertion. Blood pressure increases, blood movement in the kidneys is activated, and under the influence of certain substances remaining in the body during heavy exercise, a small amount of blood enters the urine. A good rest - and there will be no more disturbing phenomena.

Prostate cancer
About 20% of patients who come to the clinic with obvious signs of blood in the urine turn out to be sick with this particular disease. If the amount of blood is so small that it is only detected by chance during a test, the probability of prostate cancer is 5%. This disease is detected using an ultrasound-guided biopsy. The treatment method is selected depending on the degree of the disease. Sometimes removal of the prostate followed by radiation is prescribed. If the disease is at a terminal stage of development, hormonal treatment is also added.
Inflammation of the prostate - prostatitis. The presence of blood in the urine is not the most common symptom of this disease. However, in some cases they are related.

The child has

Half of children examined for hematuria are diagnosed with glomerulonephritis.

Other reasons:

• Hereditary predisposition to kidney diseases,
• Infection,
• Illiterate care of reproductive organs after birth,
• Injury to the urethra caused by the child himself during play.

A baby's blood vessels are thinner and more fragile than those of an adult. Therefore, some diseases can cause blood to enter the urine. This may be a hemorrhagic diathesis or another disease. Sometimes blood can get into the urine when being treated with certain strong drugs.

The most common cause of blood in a child’s urine is inflammatory processes in the kidneys or bladder. Girls are more predisposed to such diseases, since their urethra is shorter and the path for infection is smaller. With inflammation, the child will definitely complain of pain, urinate frequently, and cry while urinating.
Sometimes parents panic when they see their child's urine change color. But sometimes the red color does not mean the presence of blood. It may appear when consuming certain foods. If the child has not eaten anything brightly red, you should definitely and immediately visit a doctor.

During pregnancy

Blood can be detected during pregnancy at any stage of gestation. Moreover, such a symptom always makes both the woman and her doctors very nervous. Although in the overwhelming majority of cases this phenomenon is causeless ( idiopathic) and does not cause any trouble, the woman must be thoroughly examined.

Doctors believe that the presence of blood in the urine during pregnancy can be associated with changes in hormonal levels, as well as compression of the urinary organs by the uterus.
Usually, immediately after the birth of the child, all disturbing symptoms disappear and only sometimes hematuria does not go away. But in this case, it is a symptom of a disease of the bladder, urethra or kidneys.

In older people

If hematuria is detected in an elderly member of the stronger sex, it may indicate the likelihood of a microbial process that develops when bladder function is impaired and urine outflow worsens. This is likely to happen with a malignant neoplasm of the prostate, urethral stricture, as well as benign prostatic hyperplasia. Therefore, it is important to identify signs of changes in urination: incomplete emptying of the bladder, weak stream, difficulties with urination.

If hematuria in an elderly person is combined with pain in the iliac bones, this may indicate renal artery embolism. In such a patient, it is important to identify vascular and heart diseases, and also to find out whether he is taking medications for such diseases.

The appearance of hematuria after sex is a sign of cystitis

If blood in the urine is combined with pain and appears after copulation, the patient probably has postcoital cystitis. It develops against the background of inflammation caused by pathogenic microflora that penetrates the urinary organs during copulation. Next, the microorganisms rise up to the bladder.

The structure of the urinary organs in women contributes to the development of postcoital cystitis. When the urethra is positioned in such a way that seminal fluid and vaginal mucus penetrate into it during copulation, infection of the genitourinary system and the development of inflammation in the urethra and bladder are likely. The position in which copulation takes place is very important. Since the vagina, urethra and anus are in close proximity to each other, the likelihood of infection increases.
Signs of postcoital cystitis can manifest themselves both from the first sexual experiences and at a later age.

Diagnosis is carried out by a urologist based on examination and laboratory tests.
Treatment of the disease is medication; in some cases, if it is ineffective, surgery is prescribed.
To prevent the development of postcoital cystitis, one should observe hygiene requirements, use barrier contraceptives, and also avoid the penetration of sperm and vaginal secretions into the urethra.

It's not always really blood

Often the color of urine is affected by food. Thus, eating red beets gives the urine an intense reddish tint. Some dyes added to food also cause urine to become colored.
A number of medications can change the color of urine. For example, when treated for tuberculosis with rifampicin, the urine may turn orange; some patients believe that this is due to the presence of blood.

How to detect hematuria?

There are three methods for detecting blood in urine:

• Organoleptic ( by eye),
• Using a rapid test,
• Using a microscope.

The first two methods are quite approximate. Thus, when examining urine, any red dye can be mistaken for blood. And the test can give a false positive result if there is hemoglobin in the urine.
The mechanism of action of test strips for blood in urine is based on the reaction with hemoglobin of red blood cells. The tests are very sensitive. However, their results should be double-checked using laboratory tests.
These tests are more likely to produce false positives than false negatives.

How to detect the cause of hematuria?

There are many diagnostic methods for this:

• Patient interview
• Inspecting it
• General urine analysis
• Bacterial urine analysis,
• Urine cytology,
• Intravenous urography,
• Ultrasound.

In a large number of cases, only examining and interviewing the patient is sufficient. So, based on the stage of urination when blood appears, you can already suspect the cause of the disorder.
If blood is found in the first portion of urine, it means the urethra is affected.
If blood appears in the last portions of urine and is combined with pain, this indicates stones in the bladder, cystitis. With urolithiasis, blood is released if the walls of the bladder shrink around the stone during urine flow.
Sometimes all urine contains blood. And in this case, it is more difficult to establish the source of the blood.

If the presence of blood in the urine is combined with pain in the lower back or abdomen, there is a possibility of infectious inflammation, neoplasm or kidney stones. Cystitis often occurs with fairly heavy bleeding. With this disease, the patient suffers from burning or stinging when urinating.
The presence of blood in the form of clots in middle-aged patients most likely indicates the presence of a malignant tumor of the bladder. Representatives of the stronger sex have difficulties with urine excretion, for example, a sluggish stream, inhibition of urination and prolonged urination, which indicates a dysfunction of the prostate.

During the examination, women should definitely undergo a consultation with a gynecologist, and men should undergo a rectal examination. Sometimes this makes it possible to immediately identify a tumor.
In order to clarify the presence of blood in the urine and the reasons for it, you need to take an analysis, including bacterial flora.
If the patient has already had cancer, he will be prescribed cytology, which shows the composition of the cells present in the urine.

Visual examination of the urinary system

This examination is mandatory if there is blood in the urine, even in the smallest amount. Ultrasound or urography is usually used to examine the upper urinary system. To perform urography, an iodine-based contrast agent is infused intravenously. The device records the movement of the contrast agent through the urinary system. As a result, the doctor receives several x-rays showing different parts of the urinary system. This is the most widely used method for diagnosing the condition of the excretory organs and helps to detect stones and tumors in the upper parts of the urinary system.

Instead of urography, ultrasound is sometimes used together with a plain radiograph. The great convenience of ultrasound is that this type of examination is completely harmless.
If the cause of blood in the urine is small tumors of the kidney parenchyma, then ultrasound will detect them faster than urography. But if the tumor appears in the drainage system of the kidneys, urography is more effective. The benefit of any of these measures directly depends on the qualifications of the doctor. But in any case, urography and ultrasound are complementary methods. Sometimes both examinations are prescribed.
If these examinations indicate the presence of a neoplasm, computed tomography is chosen as an additional method. CT is never used as the first method of examination for such symptoms.
But neither ultrasound nor urography will detect a tumor in the bladder. Cystoscopy is used for this. In case of hematuria, this examination is required.

What to do?

Most people will feel very anxious if they find blood in their urine. And rightly so. Under no circumstances should you try to diagnose and treat yourself. You need to make an appointment for a consultation as soon as possible urologist.
In such cases, an ultrasound examination of the urinary organs, a general blood and urine test, blood sugar levels, and blood creatinine levels are usually prescribed.
Since to make a diagnosis it is important to understand from which part of the urinary system the blood enters, the doctor will interview the patient in detail and examine him.

Once the cause is determined, appropriate treatment will be prescribed:

• For injuries, this is drug therapy and, often, surgery,
• If there is a tumor in the kidneys, surgery is prescribed,
• For an autoimmune disease or infection, drug therapy is used,
• For urolithiasis, ultrasonic crushing or surgery is used,
• For bladder ailments, such as a tumor or polyp, surgical treatment is used,
• If the bladder is infected, antibiotic therapy is prescribed,
• If the urethra is infected, antibiotic therapy is prescribed,
• For diseases of the prostate gland, therapy using antibiotics is also prescribed, and in the future they usually resort to surgical treatment.

Before use, you should consult a specialist.