Emergency care for acute pyelonephritis and hematuria

Hematuria is blood in the urine. This disorder is characterized by increased production of red blood cells, which can provoke the presence of various serious diseases.

There are two types of hematuria:

• microhematuria, such a disorder can only be determined in laboratory conditions using a microscope. In patients with microhematuria, the urine may appear normal;
• macrohematuria, in this case the disorder can be determined even with the naked eye: there will be streaks of blood in the urine, it will become a pronounced red hue.

A healthy person has 1-2 red blood cells in the urine.

What is the urinary tract?

The urinary tract is the body's drainage system for removing waste and excess fluid. The urinary tract includes:

• two kidneys
• two ureters
• bladder
• urethra

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Each day, the kidneys filter 120 to 150 liters of blood to produce 1 to 2 liters of urine, which consists of waste and excess fluid. Children produce less urine than adults. Urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine until it is released through urination. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder.

Make an appointment

To make an appointment with a doctor, choose any method:

• call the clinic +7 (495) 103-99-55,
• order a call back,
• leave a request for an appointment using a convenient form on the website:

SIGN UP

At the Kuntsevo Medical and Rehabilitation Center, we have created all the conditions so that you can undergo rehabilitation from 8 am to 10 pm on weekdays and from 9 am to 9 pm on weekends.

Our center is within walking distance from the Molodezhnaya metro station.

If you are driving, a nice addition will be free parking for our visitors.

What causes hematuria?

Reasons why people may have blood in their urine include:

• infection in the bladder, kidney or prostate
• injury
• vigorous exercise
• viral diseases such as hepatitis, a virus that causes liver disease and inflammation of the liver
• sexual activity
• menstruation
• Endometriosis is a problem in women that occurs when the type of tissue that normally lines the uterus grows somewhere else, such as the bladder.

More serious reasons why people may have hematuria include:

• bladder or kidney cancer
• inflammation of the kidney, urethra, bladder or prostate - in men, the walnut-shaped lining that surrounds the urethra and helps create sperm
• bleeding disorders such as hemophilia
• Sickle cell anemia is a genetic disease in which the body produces irregularly shaped red blood cells
• Polycystic kidney disease is a genetic disease in which many cysts grow on a person's kidneys.

Why does blood appear when women urinate?

Most often, the symptom indicates the presence of fungal, viral and parasitic pathogens. Against the background of inflammation of the genitourinary system, blood clots occur during urination in women, as well as hematuria.

The color of urine may change due to menstrual flow. In addition, in the presence of hard deposits in the kidneys, hematuria often appears. As the stone passes through the organs of the excretory tract, they are traumatized, which is why hematuria is observed.

With severe physical exertion, you may experience bleeding. In this case, there is no discomfort; the phenomenon is short-term in nature. A reddish coloration of urine can occur when consuming certain dried fruits, beets, blackberries, and medications.

Hematuria may occur against the background of some gynecological diseases. It is also provoked by trauma, as well as recent cystoscopy. During diagnosis, a specialist may accidentally injure the mucous membrane of the urinary tract.

In some cases, pathologies are not accompanied by specific symptoms. For example, pyelonephritis can occur without burning, increased temperature and decreased overall tone of the body. And it is blood during urination that will be that alarming “bell”, when it appears, you need to consult a competent doctor as soon as possible.

Who is more likely to develop hematuria?

People more likely to develop hematuria may have:

• enlarged prostate
• urinary stones
• take certain medications, including blood thinners, aspirin and other pain relievers, and antibiotics
• do strenuous exercise such as long-distance running
• have a bacterial or viral infection such as streptococcus or hepatitis
• have a family history of kidney disease
• have a disease or condition that affects one or more organs

List of used literature

1. Nikolaev A. Yu., Shcherbin A. A. et al. The mechanism of hematuria in hematuric nephritis // Ter. archive, 1988, No. 6, p. 34–37.
2. Burtsev V.I., Turchina L.P. Hematuria // Clinical Medicine, 1997, No. 6, p. 66–69.
3. Pediatric nephrology [Text]: practical work. hands / ed. E. Loyman, A. N. Tsygin, A. A. Sarkisyan. - Moscow: Litterra, 2010. - 400 p.
4. Urolithiasis disease. Modern methods of diagnosis and treatment [Text] / Yu. G. Alyaev [etc.]; edited by Yu. G. Alyaeva. - Moscow: GEOTAR-Media, 2010. - 224 p. : ill. - (B-specialist doctor).

How is hematuria diagnosed?

A healthcare professional diagnoses hematuria or the cause of hematuria by:

• disease history
• physical examination
• Analysis of urine
• additional testing

Disease history

Taking a medical history can help a healthcare professional diagnose the cause of hematuria. He will ask the patient to provide a medical history, an overview of symptoms, and a list of prescription and over-the-counter medications. The healthcare professional will also ask about current and past medical conditions.

Physical examination

During a physical examination, the health care provider will often tap your abdomen and back to check for pain or tenderness in the bladder and kidney areas. A healthcare professional can perform a digital rectal exam on a man to identify any prostate problems. A doctor may perform a pelvic examination on a woman to look for the source of possible red blood cells in the urine.

Digital rectal examination . A digital rectal exam is a physical examination of a person's prostate and rectum. To perform the exam, the health care professional has the person bend over a table or lie on their side with their knees close to their chest. The health care professional places a lubricated gloved finger into the patient's rectum and feels the part of the prostate gland that lies in front of the rectum. A digital rectal exam is used to check for prostate inflammation, an enlarged prostate, or prostate cancer.

Gynecological examination . A pelvic examination is a visual and physical examination of a woman's pelvic organs. The healthcare worker has the woman lie on her back on the examination table and place her feet on the corners of the table or in supports. The health care professional looks at the pelvic organs and places a lubricated gloved finger in the vagina to check for problems that may be causing blood in the urine.

Analysis of urine

A healthcare professional can test your urine in the office with a dipstick or send it to a laboratory for analysis. Sometimes urine dipstick tests can be positive even if the patient does not have blood in the urine, resulting in a "false positive" test. A healthcare professional may look for red blood cells by examining the urine under a microscope before ordering further tests.

Before obtaining a urine sample, the health care provider may ask the woman when she last menstruated. Sometimes blood from a woman's menstrual cycle can get into her urine sample and cause a false positive test for hematuria. The test should be repeated after the woman stops menstruating.

Additional testing

Sometimes the health care professional will test the patient's urine again. If urine samples reveal too many red blood cells, your healthcare provider may order additional tests:

• Blood analysis . A blood test involves drawing blood at a health care provider's office or commercial establishment and sending the sample to a laboratory for analysis. A blood test may reveal high levels of creatinine, a waste product of normal muscle breakdown, which may indicate kidney disease. Other blood tests can detect signs of autoimmune diseases, such as lupus, or other diseases, such as prostate cancer, that can cause hematuria.
• Computed tomography (CT). CT scans use a combination of X-rays and computer technology to create images of the urinary tract, especially the kidneys. The healthcare provider may give the patient a solution to drink and an injection of contrast material. CT scans require the patient to lie on a table that slides into a tunnel-shaped device that receives X-rays. A radiologist performs the procedure in an outpatient center or hospital, and a radiologist interprets the images. The patient does not require anesthesia. A CT scan can help your doctor diagnose urinary tract stones, obstructions, infections, cysts, tumors, and traumatic injuries.
• Cystoscopy . Cystoscopy is a procedure performed by a urologist, a doctor who specializes in urinary problems, to view a patient's bladder and urethra using a cystoscope, a tube-like instrument. A health care professional performs a cystoscopy in his or her office, outpatient center, or hospital. The patient may need pain medications. Cystoscopy can detect cancer in a patient's bladder.
• Kidney biopsy . A kidney biopsy is a procedure that involves removing a small piece of tissue from the kidney. A health care professional performs the biopsy at an outpatient center or hospital. The healthcare professional will give the patient light sedation and local anesthesia. In some cases, the patient will require general anesthesia. A pathologist—a doctor who specializes in diagnosing disease—examines tissue in a laboratory. A biopsy can help diagnose if hematuria is caused by kidney disease.
• Magnetic resonance imaging (MRI). An MRI is a test that takes pictures of a patient's internal organs and soft tissue without the use of X-rays. A specially trained technician performs the procedure at an outpatient center or hospital, and a radiologist interprets the images. The patient does not require anesthesia, although patients with fear of confined spaces may receive light sedation. An MRI may include an injection of contrast material. In most MRI machines, the patient will lie on a table that slides into a tunnel-shaped device that may be open or closed at one end. Some machines allow the patient to lie in a more open space. During an MRI, the patient must remain completely still while the technician takes the images. During the procedure, the patient hears a loud mechanical knock and a buzzing sound coming from the device.

Cost of services

Correction

Conservative therapy

There are no independent methods for correcting hematuria. To eliminate this laboratory phenomenon, treatment of the underlying disease is necessary. If hematuria develops while taking an anticoagulant, it is recommended to reduce the dosage or completely discontinue it. The following medications are used as conservative therapy:

• Antibiotics.
  For the treatment of pyelonephritis, first-line drugs are penicillins and cephalosporins. For cystitis, fosfomycin trometamol is prescribed. Fluoroquinolones and macrolides are effective for prostatitis.
• Glucocorticosteroids.
  Preparations of adrenal hormones (prednisolone) are able to suppress the severity of inflammation in the glomerular apparatus and the autoimmune destruction of platelets during hemorrhagic diathesis.
• Cytostatics.
  Cytostatic agents (azathioprine, cyclosporine) are used for severe glomerulonephritis, especially for vasculitis and collagenosis. Also, combinations of chemotherapy drugs are prescribed for tumors of the kidney and bladder.
• Alpha blockers (tamsulosin).
  This group of drugs has a relaxing effect on the walls of the ureters and sphincters of the bladder, which promotes the spontaneous passage of small stones.
• Alkaline solutions.
  Potassium citrate or sodium bicarbonate are used to dissolve uric acid stones.
• Cardiac drugs.
  Patients with chronic heart failure and arterial hypertension are prescribed beta-blockers, ACE inhibitors, and potassium-sparing diuretics.

Surgery

Patients with urolithiasis undergo shock wave lithotripsy or laparoscopic stone removal; for polycystic disease, benign tumor, renal infarction, resection, nephrostomy or total nephrectomy are performed. In case of severe bilateral damage to the renal tissue with the development of end-stage renal failure, kidney transplantation can be performed for health reasons.