What is the treatment for hematuria

Microhematuria

Hhave you ever had blood in the urin?

Some of you are probably familiar with the feeling when you go to the toilet in the morning while you are still sleepy and suddenly get frightened because the urine is reddish in color or even deep red. Blood in the urine is referred to by medical professionals using the ancient Greek term hematuria. We asked Dr. Interviewed Andreas Reihl from the nephrological practice in the spinning mill.

Where does the blood in the urine come from?

Blood can come from bleeding veins (vessels) and mucous membranes of the urinary tract, i.e. the urethra, bladder, ureters (connecting tubes between kidney and bladder) and ultimately from the kidneys. Looking at the kidneys, the blood can again come from the kidney pelvis or the kidney filter.

If it comes from the kidney filter, we as nephrologists are in demand.

During urine production, healthy kidneys normally do not allow red blood cells to pass through the microscopic filter units, which we refer to as glomeruli. That has to be the case, because around 100ml of blood flow through healthy kidneys per minute. One can imagine that if this filter function didn't exist, one would bleed to death quickly.

Is Blood in the Urine an Emergency?

There is no general answer to that. Basically, blood in the urine should always be checked. Whether this has to be done in an emergency within a few hours depends on the amount of blood loss.

As soon as you can see blood in the urine with the naked eye, we speak of macrohematuria. The redder the urine, the more blood there is usually in the urine. But be careful, please don't panic! From one milliliter of blood per liter of urine, the urine is already reddish in color and thus hematuria is visible to the eye. In the case of a stronger red color and circulatory problems, we recommend an emergency presentation to the urologist or to a urological hospital department.

Some foods (e.g. beetroot, blueberries) or medication (e.g. antibiotics) can cause the urine to turn red temporarily, simulating hematuria.

If there are very small amounts of blood in the urine, which are not visible when going to the toilet and were only detected in the urine test strip (Urinstix) during a screening examination at the family doctor, gynecologist or in the routine test from the pharmacy, a microscopic urine examination should be carried out. The urine is centrifuged for this, so that possible cells settle on the bottom. If more than 5 erythrocytes per visual field can then be detected in this sediment, one speaks of microhematuria.

What are the causes of hematuria?

The causes are varied and often harmless in young patients. In female patients, a common cause is urinary tract infections (bladder infections), which, however, are usually associated with pain and burning sensation when urinating and a frequent need to urinate. Menstrual periods or intermenstrual bleeding can simulate hematuria. Blood in the urine can also be found after kidney stones have passed. Blood is often found in the urine even with indwelling catheters.

In old age, tumors in the urinary tract, mainly originating in the bladder and prostate, can be the cause of macrohematuria. If blood is visible in the urine, the urologist is therefore the first priority. In addition to imaging diagnostics using ultrasound, it is also often necessary to look into the bladder using a cystoscopy.

If the urologist cannot find a source of bleeding, he will often refer you to a nephrologist, because we are in demand with microscopic evidence of bleeding in the urine. Microhematuria can originate in the lower urinary tract as well as in the kidneys themselves. On the one hand, microhematuria, which has its origin in the kidney, can be a symptom of a harmless kidney disease. On the other hand, in rarer cases, it can also be an expression of severe kidney involvement, for example in the context of autoimmune diseases or infections, which, if left untreated, can lead to a loss of kidney function or even dialysis in a matter of weeks.

How does dDoes the nephrologist check whether the red blood cells in the urine come from the kidney filter?

If the urine strip test turns out positive for blood, the nephrologist will examine your urine under the microscope for red blood cells (erythrocytes) and other cells (white blood cells, body cells from the urinary tract) and structures (bacteria, crystals). Here, the shape of the erythrocytes provides information about whether they come from the kidney filter. Under the microscope, normal erythrocytes have the shape of an extended donut or, in Franconia, better known as "Knieküchle".

The nephrologist then looks for so-called acanthocytes. These are erythrocytes that have bulges like Mickey Mouse ears. One imagines that the erythrocytes are squeezed when they pass through the kidney filter and this force leaves bulges behind. If many of these acanthocytes are detectable in the urine, this is a sign of severe (usually extremely acute) kidney inflammation, known as glomerulonephritis. This can occur, for example, in the context of autoimmune diseases (e.g. with vasculitis) or infections.

The nephrologist will usually get an overall picture of your kidney function through detailed questioning, physical examination and further special laboratory tests of your blood. If acanthocytes are detected, a kidney biopsy is often necessary, i.e. a tissue removal and tissue examination to clarify the diagnosis and plan a therapy.

What does the patient notice with glomerulonephritis?

Unfortunately, mostly nothing at all. Even the kidney values ​​can still be in the normal range. Sometimes skin abnormalities or infections are associated with glomerulonephritis. Some notice foamy urine due to increased protein excretion.

Many rheumatological diseases, such as systemic lupus erythematosus, can cause microhematuria with glomerulonephritis.

Typically, with microscopic hematuria in the presence of glomerulonephritis, high blood pressure occurs suddenly.

Can the kidneys then still be saved?

Often yes! The earlier the diagnosis is made in the tissue and the lower the kidney values ​​are at the time the diagnosis is made, the more successful targeted treatment can be. For treatment, immunomodulatory drugs such as cortisone, chemotherapeutic agents or antibodies that specifically act on cells of the immune system are administered.

In summary, microhematuria is an emergency that should be presented to the nephrologist within a few days or weeks in order to rule out manifest glomerulonephritis or to treat it in good time.