hematuria

(hē″mă-toor′ē-ă)

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[hemat- + -uria]
Blood in the urine.

CAUSES
Blood may appear in the urine as a result of many conditions, including contamination during menstruation or the puerperium; internal trauma or kidney stones; vigorous exercise; urinary tract infections or systemic infections with renal involvement; some cases of glomerulonephritis; vascular anomalies of the urinary tract; or cancers of the urethra, bladder, prostate, ureters, or kidneys.

DIAGNOSIS
The clinical history may help determine the cause of hematuria. Kidney stones often cause hematuria associated with intense flank pain that radiates into the groin. Hematuria in a child with recent sore throat, new edema, and hypertension may reflect a poststreptococcal glomerulonephritis. Urinary bleeding in a patient with abdominal pain and an enlarged or prosthetic aorta may have a fistulous connection to a ureter, a true surgical emergency. In the laboratory, microscopic examination of the urine also provides clues to the cause of bleeding. Red blood cells from the upper urinary tract are often deformed or misshapen whereas those from the urethra or bladder have a normal microscopic appearance. The urine may appear tea-colored, slightly smoky, reddish, or frankly bloody.

PATIENT CARE
In patients over the age of 35 who have persistent microscopic hematuria without obvious cause, the American Urological Association recommends cystoscopy (followed by upper urinary tract imaging if cystoscopy does not reveal a cause).

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