The presence in the urine cellular elements of the blood, protein complexes, an unusual amount of electrolytes, disturbance of acid-alkaline balance is always considered as an important symptom, which requires identification of the cause.
In the research process is necessarily performed urine microscopy of sediment obtained after centrifugation. The composition of cells and formations allows to diagnose diseases of the urinary system, even to find out the level of the lesion.
Erythrocytes in the urine – one of the symptoms of urological pathology. In the diagnosis takes into account not only quantitative evaluation, but also is the study of qualitative properties of changes in the biochemical composition of the selected cells.
Not always the presence of erythrocytes in the urine in medicine is considered to be hematuria. Found that per day in urine is transferred about 2 million erythrocytic cells.
Based on microscopy of sediment in the overall analysis, this means that in the field of view there are:
- up to three red blood cells in females;
- one in men.
Babies in the neonatal period is allowed 2-4 cells in field of view. This is due to a temporary functional disability of the filtration membrane of the kidneys.
This amount is defined as the rate of red blood cells in the urine. Elevated values are hematuria (literally “blood in urine”).
Practically it is divided into:
- the microhematuria – if urine (urine) remains a light yellow, transparent;
- gross hematuria – urine collected for analysis, the patient sees a reddish-brown color, defined as “meat slops”, or a selection of fresh drops of blood on the toilet you notice at the end of urination in certain diseases.
Why is it important to red blood cells?
Why is detection of red blood cells in the urine is suspicious for a pathology? Because of their permanent “dwelling” is the bloodstream, not the urine. These are the most numerous blood cells. Produced in the bone marrow, the bones of the skull, spine, ribs. In infants the additional synthesis are the end part of the tubular bones of the extremities.
An important feature of red blood cells – the structure of the membrane. She is able through itself to pass molecules of oxygen, carbon dioxide, sodium, potassium, water.
90% of the mass of cells accounts for the complex biochemical compound is a protein with iron – hemoglobin
Because of the large size of the red blood cells cannot pass through the healthy membrane of the glomeruli and into the urine.
The main functions in the body are:
- ensuring the delivery of oxygen from the pulmonary tissue to the periphery, and the carbon dioxide molecules back;
- education individual antigenic specificity of blood groups in connection with the presence of agglutinogens;
- support acid-alkaline balance and the required osmotic pressure for the active biochemical reactions in the body.
The duration of the life of about three months. The destruction and elimination of aged cells occurs in the spleen and liver. The process of “production” of erythrocytes are very sensitive to the conditions of the external and internal environment.
How red blood cells get into urine?
Hematuria means that red blood cells in the urine were able to get:
- broken through the wall of the vessels supplying the structures of the urinary tract, e.g., inflammation, injury, and destruction by the tumor of the urethra, bladder, ureters, kidneys;
- as a result of gross violation of passing ability of the membrane of the renal capillaries in the nephritis of different origin;
- with stagnation in the venous system of the pelvic organs (phlebitis, mechanical compression of the veins hydronephrosis).
Therefore, the red blood cells in the urine is always cause for suspicion of the violation of the activity of Executive structures.
Dark color urine should be a cause for concern
The specific causes of hematuria
The reasons for getting red blood cells from the vascular bed into the urine can be a reaction to physiological processes.
The microhematuria can cause:
- significant overheating in the sun, in the bath;
- excessive physical loads;
- previous stressful situation;
- a generous intake of alcohol, spicy or salty foods.
Among the pathological conditions of erythrocytes in the urine is accompanied by:
- diseases of the urinary tract (acute or chronic glomerulonephritis, cystitis, urolithiasis, hydronephrosis, urethritis, pyelonephritis rarely, tumors and tuberculosis of the kidneys);
- injury – abdominal and pelvic organs with damage structures of the kidneys, bladder, rupture of the ureter;
- androgenic and gynaecological diseases – red blood cells in the urine in men are not uncommon in the prostate adenoma, prostatitis, women with cervical erosion, fibroids, uterine bleeding;
- fevers of infectious origin (toxic damage to the kidneys and blood vessels), diathesis (hemorrhagic kapilliarotoxicos), illnesses with significant fever;
- blood disorders with reduced clotting (hemophilia, thrombocytopenia), congestion (heart failure);
- hypertension of any origin;
- the negative impact of drugs in the treatment of sulfonamides, in large doses of vitamin C, overdose of anticoagulants, methenamine.
In the practice of urology hematuria are distinguished by their origin:
- caused by damage to the urinary tract, the kidneys;
- not related to the urinary system, for example, by lowering the clotting of blood.
In the mechanism of renal hematuria plays the role as a mechanical compression and destructive processes in the kidney tissue. Part of pathology that occur with red blood cells in the urine, provoked by the development of renal venous hypertension, if the violation of the venous outflow and venous develops renal pelvis reflux.
Necrosis of renal tissue at the angitis inflammation of immune origin in the case of hereditary and acquired diseases affects the filtration process through the basal membrane of the glomeruli.
Hematuria can cause inflammation of the interstitial tissue and tubular epithelium
Renal hematuria is divided:
- at the macroscopic – is typical for trauma, tumors, kidney stones, nephroptosis, malformations of renal vessels, thrombosis of the renal veins;
- the microhematuria can occur with kidney disease (primary glomerulonephritis, hereditary nephritis, systemic diseases, alcohol and gouty nephropathy, medicinal poisoning).
In acute glomerulonephritis, IgA nephropathy, goodpasture’s syndrome, lumbalgia-hematuric syndrome possible gross hematuria.
Thanks to a more detailed examination of the patient with cystoscopy and clinical features could distinguish between:
- unilateral hematuria – urological diseases associated with intense pain;
- two – way- accompanied nephropathy, is typically painless form, combined with detection of protein in the urine and cylinders.
Quantitative and qualitative evaluation of hematuria
Found that when the content of in urine up to 100 erythrocytes per field of view, its color is not changed. This means that the term “microscopic hematuria” can be considered as an isolated erythrocytes and a moderate amount.
But in diagnostics it is important to investigate more precisely the sediment to secure even the minimum level of red blood cells. Therefore, in clinic, we use methods Nechiporenko, Amburgo (number of leukocytes, erythrocytes, and cylinders in ml of urine), conduct re-examinations. The norm is up to 1000 cells in ml.
The qualitative composition of red blood cells in the urine are divided into:
- unaltered (fresh),
The presence of a particular species or the advantages of erythrocytes can be judged on the nature of the pathological process:
- unmodified red blood cells – originate from the urinary tract, often combined with leukocyturia, they indicate presence of stones, tumors or polyps, destroy the structure of cellulose, accompanied by tissue necrosis (infarction of the kidney), prostate adenoma;
- leached erythrocytes or changed – lack hemoglobin, have a wrinkled form, often combined with the appearance of protein in urine can mean a patient develops nephrotic syndrome in acute or chronic glomerulonephritis, chronic renal disease, hypertension. toxic nephropathy, causes of leached cells are always associated with kidney damage.
Simultaneous detection in urine a lot of red blood cells, leukocyturia and protein indicates a pronounced inflammatory process, prolonged injury of the mucous layer of the ureters, bladder or urethra salts, stones.
In clinical manifestation of disease are:
- asymptomatic or painless gross hematuria often appears suddenly include blood clots, is quite reasonable panic in the patient, in the diagnosis is needed urgently to exclude a tumor of the bladder or kidneys;
- gross hematuria with the formation of large shapeless clots in the difficult allocation and retention of urine indicates bleeding in the urinary bladder;
- if clots have a wormlike form, is indicative of their formation in the ureters and the source of the bleeding must be sought in the kidney or the pelvis, rarely the same symptom occurs when polycystic, stones in the kidney (gross hematuria is usually preceded by an attack of renal colic).
In clot formation involves fibers of fibrin
If you suspect nephroptosis pathological mobility of the kidney has a value of orthostatic (hematuria appears or is enhanced after exercise).
How to determine the level of the lesion urinary organs?
To be sure roughly where is the lesion of the urinary tract use trehstakannoy trial. The patient is instructed to urinate consistently in the three tanks. Then explore each of them.
The following options are possible interpretations:
- red blood cells only in the first portion (initial hematuria) – indicates pathology of the urethra, possible injury to stone, inflammation, swelling;
- only end portions (terminal hematuria) – is a symptom of disease of the bladder (cystitis cervical, prostate tumor, pinched stone in the urethral canal);
- erythrocytes in all tanks (total hematuria) is talking about the renal disease or damage to the ureter, macrohematuria signs along with the dysuria is typical for hemorrhagic form of cystitis, urolithiasis, tuberculosis, or parasitic inflammation.
For accurate diagnosis the patient will need to hold:
- zitostaticescoe research;
- intravenous urography;
- Ultrasound of the kidneys;
- you may need a bone scan.
Almost precisely the cause of the hematuria is very difficult.
We use methods such as:
- computed tomography;
- retrograde pielografia;
The role of clinical study of urine test for this purpose is very limited.
From any state it is necessary to distinguish hematuria?
Most often similar symptoms occur when urethrorrhea, gemoglobinurii, myoglobinuria.
If the patient complains of changed color of urine, the doctor should consider and exclude the effect of eating foods such as beetroot, some medicines (Aspirin, vitamin b12, Analgin)
The teenage girls and women the red blood cells get into the urine from the vagina during menstruation. In true hematuria urine has a cloudy appearance in contrast to the allocation of hemoglobin, myoglobin, in which the urine remains clear, despite the red color.
Urethrorrhea – are often a consequence of traumatic interventions, diagnostic and therapeutic procedures (probing the urethra, cystoscopy, catheterization). Spotting emerge from the urethra outside of urination.
Hemoglobinuria – called intravascular hemolysis of blood and the release of significant amounts of intracellular hemoglobin. In the study of erythrocytes in the sediment not detected. The patient suffers from pain in the lower back, cramps during urination. Urine almost black in color.
Similar pathology occurs:
- transfusion Ethnography blood;
- poisoning by sulphuretted hydrogen, the poison of the snake;
- against the background of severe typhus, scarlet fever, diphtheria.
- massive burns;
- hemolytic anemia.
Myoglobinuria manifests as a symptom of compartment syndrome (myoglobin of muscle crushed into the blood then into the urine). The urine is dark red in color find the people extracted from the rubble of the buildings during the terrorist attacks, disasters. Part of myoglobin block the tubules and disrupts kidney function. To lower the level of abnormal substances by hemodialysis.
Timely diagnosis and the correct treatment pathology much more important problem of how to get rid of red blood cells in the urine. Because only therapy will allow you to restore renal structure and return to the blood vessels cellular elements.