BLOOD IN THE URINE (HEMATURIA)There

BLOOD IN THE URINE (HEMATURIA)
There are many reasons why a person can have blood in their urine. This condition, known as hematuria, can be an indication of a serious problem or conversely, have no negative connotation. What should you do if you find out that there's blood in your urine? Read the following to learn more.
What is hematuria?
Hematuria is defined as the presence of red blood cells in the urine. It can be characterized as either "gross" (visible to the naked eye) or "microscopic" (visible only under the microscope). Microscopic hematuria is an incidental finding often discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria could prompt you to visit the doctor. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra. It is estimated that hematuria occurs in 2.5 to 21 percent of the population. In many patients no specific cause is found; however, hematuria may be a marker for infection, stone disease or urinary tract cancer. Risk factors for significant underlying disease include: smoking, radiation, overuse of some pain medicines and exposure to certain chemicals.
What are the common causes of hematuria?
Blood in the urine is often not a sign of significant disease. Studies have shown that between nine to 18 percent of normal individuals can have some degree of hematuria. However, hematuria can be a sign of an important medical condition requiring treatment. Below is a list of common causes of hematuria:
• Bladder Cancer
• Kidney Cancer
• Prostate Cancer
• Ureteral Cancer
• Urethral Cancer
• Urinary Stone Disease
• Urinary Tract Infection
• Pyelonephritis (Kidney Infection)
• Benign Prostatic Hypertrophy (Enlarged Prostate)
• Renal (Kidney) Disease
• Radiation or Chemical Induced Cystitis (Bladder Irritation)
• Injury to the Urinary Tract
• Prostatitis (Prostate Infection)
• Exercise Hematuria
How is hematuria diagnosed?
Visible hematuria is often worrisome to the patient and prompts them to seek medical attention; however, microscopic hematuria can be just as severe. It often has no symptoms and is detected on a urine dipstick test. If the dipstick test is positive for blood the amount of blood is often determined by looking at the urine with a microscope. If three or more red blood cells (RBC) are seen per high power field on two of three specimens, further evaluation to determine a cause is recommended.
What additional tests are needed?
Any patient with gross hematuria or significant microscopic hematuria should have further evaluation of the urinary tract. The first step is a careful history and physical examination. Laboratory analysis consists of a urinalysis and examination of urinary sediment under a microscope. The urine should be evaluated for protein (a sign of kidney disease) and evidence of urinary tract infection. The number of red blood cells per high-powered field should be determined. In addition the shape of the blood cells should be evaluated. This can help determine where the bleeding is coming from. In patients with white blood cells in the urine, a urine culture should be performed as well. A urinary cytology is also obtained to look for abnormal cells in the urine. A blood test should also be done to measure serum creatinine (a measure of kidney function). Those patients with significant protein in their urine, abnormally shaped red blood cells, or an elevated creatinine level should undergo general medical evaluation for the presence of kidney disease.
A complete urologic evaluation for hematuria also includes X-rays of the kidneys and ureters to detect kidney masses, tumors of the ureters and the presence of urinary stones. This traditionally consisted of an intravenous pyelogram (IVP). In this study, a radiographic dye is injected into the blood stream and X-rays are taken as the kidneys excrete the dye. This study has trouble detecting small renal masses and is often combined with a renal ultrasound.
Many physicians may opt for other imaging studies such as a computerized tomography (CT) scan. This is the preferred method of evaluating kidney masses and is the best modality for the evaluation of urinary stones. Recently many urologists have been using CT urography. This allows the urologist to look at the kidneys and ureters with one X-ray test. In patients with an elevated creatinine or an allergy to X-ray dye, magnetic resonance imaging (MRI) or retrograde pyelography is used to evaluate the upper urinary tract. During retrograde pyelography, the patient is taken to the operating room and dye is injected up the ureters from the bladder and then images are taken.
The main limitation of these imaging studies is the inability to evaluate the bladder; therefore a cystoscopic evaluation is required. This is usually performed in the office under local anesthesia with either a rigid, or more commonly, a flexible cystoscope. After applying a topical analgesic to the urethra the urologist inserts an instrument called a cystoscope through the urethra and into the bladder. Looking through the cystoscope the doctor can examine the inner lining of the bladder and urethra for abnormalities.
What happens if no abnormality is found?
In at least eight to 10 percent of cases no cause for hematuria is found. Some studies have demonstrated an even higher percentage of patients have no cause. Unfortunately, studies have shown that urologic malignancy is later discovered in one to three percent of patients with negative work-ups. Therefore, some form of follow-up is recommended. Recommendations regarding follow-up are sparse and no clear consensus has been agreed upon. Consideration should be given to repeating the urinalysis and urine cytology at six, 12, 24 and 36 months. Immediate re-evaluation with possible cystoscopy and repeat imaging should be performed in the face of gross hematuria, abnormal urinary cytology or irritating urinary symptoms such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is needed.
How will hematuria be treated?
Treatment will be based on a physician's evaluation of the patient's condition, symptoms and medical history along with the cause of the hematuria.

Hasil (Melayu) 1:

DARAH DALAM AIR KENCING (HEMATURIA)Terdapat banyak sebab mengapa seseorang boleh mempunyai darah dalam air kencing mereka. Keadaan ini, dikenali sebagai hematuria, boleh menjadi petunjuk masalah yang serius atau sebaliknya, mempunyai konotasi negatif tidak. Apa yang perlu anda lakukan jika anda mengetahui bahawa terdapat darah dalam air kencing? Membaca perkara-perkara berikut untuk mengetahui lebih lanjut.Apakah hematuria?Hematuria ditakrifkan sebagai kewujudan sel-sel darah merah di dalam air kencing. Ia boleh dikategorikan sebagai "kasar" (dilihat dengan mata kasar) atau "mikroskopik" (dilihat dibawah mikroskop tersebut). Mikroskopik hematuria adalah sampingan untuk mencari sering ditemui dalam ujian air kencing sebagai sebahagian daripada penilaian perubatan yang rutin, manakala hematuria kasar boleh meminta anda untuk melawat doktor. Hematuria boleh berasal dari mana-mana laman di sepanjang saluran kencing, termasuk buah pinggang, ureters, pundi kencing, prostat dan uretra. Adalah dianggarkan bahawa hematuria terjadi di 2.5 hingga 21 peratus daripada penduduk. Ramai pesakit tiada sebab tertentu didapati; Walau bagaimanapun, hematuria mungkin petanda jangkitan, penyakit batu atau kanser saluran kencing. Faktor risiko bagi penyakit punca penting termasuk: Merokok, Sinaran, penggunaan yang berlebihan daripada sesetengah ubat-ubatan sakit dan pendedahan kepada bahan kimia tertentu.Apakah punca-punca biasa hematuria?Darah dalam air kencing bukanlah selalunya tanda-tanda penyakit yang ketara. Kajian telah menunjukkan bahawa antara sembilan hingga 18 peratus daripada individu-individu yang normal boleh mempunyai tahap hematuria. Walau bagaimanapun, hematuria boleh menjadi tanda keadaan perubatan penting yang memerlukan rawatan. Berikut adalah senarai penyebab utama hematuria:• Kanser pundi kencingKanser buah pinggang •• Barah prostat• Kanser ureteral• Urethral kanser• Penyakit batu kencing• Jangkitan saluran kencing• Pyelonephritis (jangkitan buah pinggang)• Benign Prostatic Hypertrophy (diperbesarkan prostat)• Penyakit ginjal (buah pinggang)• Sinaran atau kimia Induced Cystitis (kerengsaan pundi kencing)• Kecederaan pada saluran kencing• Radang (prostat jangkitan)• Senaman HematuriaBagaimana hematuria dikesan?Hematuria boleh dilihat sering COMPREHENSIVE kepada pesakit dan menggesa mereka untuk mendapatkan rawatan perubatan; Walau bagaimanapun, mikroskopik hematuria boleh hanya teruk. Ia selalunya tidak menunjukkan sebarang gejala dan dikesan dalam air kencing dipstick ujian. Jika ujian dipstick adalah positif bagi darah jumlah darah selalunya ditentukan dengan melihat air kencing dengan mikroskop yang. Jika tiga atau lebih sel darah merah (RBC) dilihat satu bidang kuasa tinggi dua daripada tiga spesimen, seterusnya penilaian untuk menentukan punca adalah disyorkan.Apakah ujian tambahan diperlukan?Mana-mana pesakit dengan hematuria kasar atau hematuria mikroskopik yang penting harus mempunyai tambahan penilaian saluran kencing. Langkah pertama adalah sejarah yang teliti dan pemeriksaan fizikal. Analisis makmal terdiri daripada urinalysis dan pemeriksaan kencing sedimen di bawah sebuah mikroskop. Air kencing perlu diteliti untuk protein (merupakan tanda penyakit buah pinggang) dan bukti jangkitan saluran kencing. Bilangan sel-sel darah merah satu berhibur medan harus ditentukan. Di samping itu bentuk sel-sel darah yang perlu diteliti. Ini boleh membantu menentukan di mana ada pendarahan datang dari. Pada pesakit dengan sel-sel darah putih di dalam air kencing, air kencing budaya hendaklah dilakukan juga. A cytology kencing juga diperolehi untuk mencari sel-sel yang tidak normal dalam air kencing. Ujian darah juga akan dilakukan untuk mengukur creatinine serum (pengukur fungsi buah pinggang). Pesakit dengan signifikan protein dalam air kencing mereka, bogel berbentuk sel-sel darah merah, atau tahap creatinine bertingkat yang perlu menjalani penilaian perubatan am untuk kehadiran penyakit buah pinggang.Penilaian yang lengkap urologic hematuria juga termasuk X-ray buah pinggang dan ureters untuk mengesan orang ramai buah pinggang, tumor ureters tersebut dan kehadiran batu kencing. Secara tradisional ini terdiri daripada satu larutan pyelogram (IVP). Dalam kajian ini, pewarna radiografi disuntik ke dalam aliran darah dan X-ray akan diambil kerana buah pinggang mengeluarkan bahan pewarna tersebut. Kajian ini mempunyai masalah untuk mengesan orang ramai buah pinggang yang kecil dan sering digabungkan dengan satu ultrasound buah pinggang.Pakar-pakar perubatan yang banyak boleh memilih untuk kajian-kajian pengimejan yang lain seperti imbasan tomografi berkomputer (CT). Ini adalah kaedah yang sesuai untuk menilai rakyat jelata buah pinggang dan modaliti terbaik bagi menilai kencing batu. Tempahan banyak urologists telah menggunakan CT urography. Ini membolehkan pakar Urologi untuk melihat buah pinggang dan ureters dengan satu ujian sinar-x. Pada pesakit dengan creatinine yang bertingkat atau Alergi yang ke dye sinar-x, pyelography songsang atau pengimejan resonans magnetik (MRI) digunakan untuk menilai saluran kencing atas. Semasa berundur pyelography, pesakit akan dibawa ke bilik pembedahan dan dye disuntik ureter dari pundi kencing dan kemudian gambar yang diambil.Had utama pengajian pengimejan ini adalah ketidakupayaan untuk menilai pundi kencing; oleh itu penilaian yang cystoscopic adalah diperlukan. Ini biasanya dilakukan di pejabat di bawah bius setempat sama ada yang tegar, atau lebih biasa, cystoscope yang fleksibel. Selepas menggunakan satu analgesic topikal uretra yang pakar Urologi di Selit instrumen yang dikenali sebagai cystoscope yang melalui uretra di dan ke dalam pundi kencing. Mencari melalui cystoscope yang doktor boleh memeriksa lapisan dalam pundi kencing dan uretra untuk keabnormalan.Apa yang berlaku sekiranya keabnormalan tiada didapati?In at least eight to 10 percent of cases no cause for hematuria is found. Some studies have demonstrated an even higher percentage of patients have no cause. Unfortunately, studies have shown that urologic malignancy is later discovered in one to three percent of patients with negative work-ups. Therefore, some form of follow-up is recommended. Recommendations regarding follow-up are sparse and no clear consensus has been agreed upon. Consideration should be given to repeating the urinalysis and urine cytology at six, 12, 24 and 36 months. Immediate re-evaluation with possible cystoscopy and repeat imaging should be performed in the face of gross hematuria, abnormal urinary cytology or irritating urinary symptoms such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is needed.How will hematuria be treated?Treatment will be based on a physician's evaluation of the patient's condition, symptoms and medical history along with the cause of the hematuria.