intermittent hematuria
Introduction
Introduction Hematuria refers to urinary red blood cells 3 HP, centrifuged urinary red blood cells > 5 HP, or 12 hours urine Addis count > 500,000, is a common urinary system symptoms in children. The causes are urinary tract inflammation, tuberculosis, stones or tumors, trauma, drugs, etc., which have a great impact on the body. In recent years, there is no obvious accompanying symptom of hematuria, and most of them are glomerular hematuria, which has been widely regarded and studied. Intermittent hematuria is a symptom that occurs when hematuria occurs. It is mainly improved by actively treating the primary disease.
Cause
Cause
1. Kidney and urinary tract disease
(1) Inflammation: acute and chronic glomerulonephritis, acute and chronic pyelonephritis, acute cystitis, urethritis, urinary system tuberculosis, urinary system fungal infections, etc.
(2) stones: renal pelvis, ureter, bladder, urethra, stones in any part, when the stone moves through the urinary tract, it is easy to cause hematuria is also easy to secondary infection. Large stones can cause urinary tract obstruction and even cause kidney damage.
(3) Tumor: Hematuria can occur when a malignant tumor of any part of the urinary system or a malignant tumor of an adjacent organ invades the urinary tract.
(4) Trauma: refers to violence and urinary system.
(5) Drug stimulation: such as sulfonamide, phenol, mercury, lead, arsenic poisoning, a large amount of infusion of mannitol, glycerol and so on.
(6) Congenital malformation: polycystic kidney, congenital glomerular basement membrane ultrathin, nephritis. Nutcracker phenomenon, the disease is caused by congenital malformation of the left kidney vein between the abdominal aorta and superior mesenteric artery, causing intractable microscopic hematuria called nutcracker phenomenon. The right renal vein is directly injected into the inferior vena cava, and the left renal vein is injected into the inferior vena cava through an angle formed by the abdominal aorta and the superior mesenteric artery. Normally, the angle is 45°~60°. If the congenital angle is too small or is filled with mesenteric fat, enlarged lymph nodes and peritoneum, the nutcracker phenomenon can be caused. Diagnosis mainly depends on CT, B-ultrasound, renal vein angiography. Treatment must be corrected surgically.
2. Systemic diseases
(1) Hemorrhagic diseases: thrombocytopenic purpura, allergic purpura, hemophilia, leukemia, malignant histiocytosis, aplastic anemia, and the like.
(2) connective tissue disease: systemic lupus erythematosus, dermatomyositis, nodular polyarteritis, scleroderma and the like.
(3) Infectious diseases: leptospirosis, epidemic hemorrhagic fever, filariasis, infectious bacterial endocarditis, scarlet fever, and the like.
(4) Cardiovascular diseases: congestive heart failure, renal embolism, and renal vein thrombosis.
(5) Endocrine and metabolic diseases: gout kidney, diabetic nephropathy, hyperparathyroidism.
Examine
an examination
Related inspection
Mid-stage urinary bacterial culture count urinary system CT examination urine routine
Laboratory inspection:
1. Urine routine examination:
Urine routine examination is the easiest and most reliable way to diagnose urinary tract infections. It is advisable to leave the first urine test in the morning. More than 5 (>5 HP) white blood cells in each high power field are called pyuria, acute urinary tract. In addition to pyuria in infection, white blood cell casts, bacteriuria, sometimes accompanied by microscopic hematuria or gross hematuria, especially in Brucella, Nocardia, actinomycetes, Mycobacterium tuberculosis infection, occasionally trace Proteinuria, if more proteinuria, suggests glomerular involvement. It is worth mentioning that pyuria does not mean that the urinary tract must be infected, because pyuria can be divided into infectious pyuria and aseptic pyuria, aseptic pyuria can be seen in various tubulointerstitial nephritis, tubulointerstitial nephritis Wide range of causes, common disease with reactive tubulointerstitial nephritis (ie, tubulointerstitial nephritis caused by systemic infection), allergic tubulointerstitial nephritis (many drugs can be caused), non-steroidal anti-inflammatory drugs related Kidney disease, heavy metal toxic nephropathy, radiation nephritis, reflux nephropathy and various idiopathic tubulointerstitial nephritis.
2. Urine bacterial culture:
In the past, it was considered that the cleaned mid-stage urine culture colony count >100,000/ml had clinical significance, but only about 70% of Gram-positive bacteria caused urinary tract infections with colony counts exceeding 100,000/ml, and another 20% to 30%. The patient's colony count is only 1000-100,000/ml.
Diagnosis
Differential diagnosis
1. Urinary calculi: including kidney, ureter, bladder or urethra stones.
2. Genitourinary infections: such as pyelonephritis, renal tuberculosis, bladder urethritis, prostatitis, etc.
3. Primary nephritis: including acute and chronic nephritis, focal nephritis, benign acute hemorrhagic nephritis.
4. Secondary nephritis: purpuric nephritis, lupus nephritis, IgA nephropathy.
5. Genitourinary tumors: kidney tumors, ureteral tumors, bladder tumors, prostate tumors, etc.
6. Other urinary diseases: such as renal ptosis, kidney, congenital polycystic kidney disease.
7. Urinary system damage: damage to the kidneys caused by various chemicals or drugs, hematuria caused by sulfa drugs.
Normal urine contains very small amounts of red blood cells. Urine that has not been centrifuged can have 0 to 2 red blood cells per high power field under the microscope. If it exceeds this number, it is hematuria.
