Gross Hematuria

Gross Hematuria - the presence of visible blood in the urine.

The blood can come from bleeding in any organ in the urinary tract and be seen while peeing. Blood presence in urine can be psychologically alarming and potentially caused by a serious urinary tract problem that should be brought to the attention of a medical professional and diagnosed by various medical and urological tests. This is especially the case in case of chronic hematuria since there is enough blood present that it can be detected by the naked eye.

Gross hematuria can result from as little as 1mL of blood in 1L of urine. Red or dark-colored urine can also be also a common misdiagnosis due to the many reasons urine can take on the appearance of being red or bloody.

The medical community has traditionally made the distinction between glomerular and extraglomerular bleeding, separating nephrologic and urologic diseases. Glomerular or nephronal hematuria is due to blood originating in the nephron. Casts in the urine can indicate disease at the glomerular level. The presence of proteinuria suggests a glomerular source of blood loss.

Isolated hematuria is hematuria without proteinuria (no protein in urine). Isolated hematuria is typically associated by extraglomerular bleeding. Reasons for red blood cells to appear in urine in heavy volume, causing gross hematuria are urological malignancy, kidney stones, injury, infection, or medications.

Hematuria and Age

Age is an important factor in diagnosing and suspecting the cause of hematuria. Children and older adults are both at risk of hematuria, but for quite different reasons. Childhood causes of hematuria may differ greatly from those in the adult. Hypercalciuria is a common cause of hematuria in children but is rare in adults. Older adults are at a great risk of cancer and kidney problems.

Common False Hematuria - Pigmentueria

Ingested substances or various chemicals in the body can cause color change in the urine when not processed correctly by the body. The result is often a mistaken enterpretation of the dark or red urine for blood. Red urine which is not real hematuria is sometimes called transient hematuria and it can be caused by strenuous exercise, endogenous sources, food or drugs.

Common body chemicals are Bilirubin, Myoglobin, Urobilin, Porphyrins and Hemoglobin. Foods that cause transient hematuria are rhubarb, blackberries, blueberries, paprika, beets, tomatoes, artificial food colors, and other red-colored foods or drinks. Drugs causing pigmenturia are Rifampin, Metronidazole, Phenazopyridine, Nitrofurantoin, Prochlorperazine, Phenytoin, Sulfonamides, Chloroquine, Phenolphthalein, Quinine, Levodopa, Desferoxamine, Methyldopa, Adriamycin.

If a person suspects they are seeing gross hematuria, a doctor will conduct a careful pain history symptom analysis. The characteristics of the hematuria can often help understand the cause and location where the bleeding originated. Glomerular source of bleeding usually results in persistent microscopic hematuria, with or without periods of gross hematuria. In renal (kidney) sources of hematuria, the blood is equally dispersed throughout the urine stream and does not clot. If there are clots in the urine, they can occur at different parts of the urine stream. Clots at the beginning of the urine stream are symptoms of a urethral cause. Hematuria occurring at the end of the urine stream may occur with a prostatic, bladder, or trigonal cause of hematuria.

Risk of Hematuria

History of smoking and drinking alcohol generally increase the risk of many different diseases, and urological diseases as well. Occupational exposure to harsh chemicals or dyes is known to increase risk of developing urinary tract problems. Older age is a risk factor and so is patient history of urologic disorders. Urinary tract infection history can also increase urological disease risk.

About 25% of all hematuria and gross hematuria cases are due to urinary tract infections. Kidney stones are responsible for about 20% of bloody urine instances. Kidney stones also cause cloudy urine and urine sediments to appear in urine. Approximately 10% of hematuria patients never find out the source of the blood, even after various urinalysis and imaging tests. Urologic malignancy (urinary tract cancer) risk increases with age and more testing is recommended for older people experiencing even short bouts of hematuria. Men tend to be at a higher risk than women.

Hematuria Not Due To Urinary System Bleeding

Since the blood appears in urine, many people tend to associate the source of the bleeding with the urinary system. This isn't always correct. The blood can originate in many different organs in the body and simply have the body remove the blood from the internal bleeding via urination.

Importance of Prevention

Since hematuria can occur from a tremendous number of reasons that do not necessarily have to take root in the urinary tract, it is important to note that a lifestyle aimed to prevent health problems from occurring is very important. While no one is guaranteed to not develop health problems, a healthy lifestyle of proper diet and exercise balance will go a long way to help prevent many health problems from happening to you.

A healthy diet is a very underemphasized factor in preventing health problems from occurring. Plant based foods such as whole grains, fruits and vegetables have many anti-oxidants which rid your body of harmful substances and help clear up your arteries from the cholesterol that clogs the arteries. A person with healthy arteries is less likely to develop blood or heart related problems. In addition, healthy arteries will ensure that all your organs are getting the right amount of nutrients they need since the blood stream will be healthier and better able to supply every organ with enough nutrients.

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