Management of Patients with Haematuria Complaints
Hematuri is a medical term that describes the discovery of blood in the urine. Hematuria is an important phenomenon in the field of urology that reflect a variety of renal diseases and channel. Hematuri always causes sufferers seek medical help. A person who suffers hematuri should be examined more to see to it that causes localized bleeding and that can be known and determined the severity and persistence. When we review the possible causes of each patient with hematuri hematuri should we consider a serious condition.
Hematuri clinically divided into two groups, namely hematuri macroscopic (= makrohematuri) and hematuri microscopic (= mikrohematuri). Hematuri macroscopic urine is mixed with blood and can be seen with the naked eye. Makrohematuri already can occur if there is 1 cc of blood in 1 liter of urine. The color of urine from gross hematuria originating from the glomerulus brown, tea or coca-cola, while gross hematuria originating from the lower urinary tract (bladder or urethra) colored younger.
Mikrohematuri hematuri which is in plain view can not be seen as the red-colored urine, but on microscopic examination found more than 2 red blood cells per field of view. If the enlargement of 500 times in urine sediment was found more than ten erythrocyt it will give a positive benzidine test. Presence of hematuria should be confirmed by urine sediment examination in the microscope, because many causes other than blood clots that can cause red or brown urine and give a false positive dipstick test.
Isolated microhematuria, with no history or abnormalities on routine urine examination. Urinalysis should be repeated 2 or 3 times in recent months (without preceded by physical exercise) before the start of the next inspection. When microscopic hematuria menetao, a thorough anamnesis should dibut about drug use, family history of hematuria, deafness, kidney failure, urinary tract stones, a history of sickle cell disease or trait.
Macroscopic hematuria that continues over time can be life threatening because it may cause diseases such as: the formation of blood clots that can block the flow of urine, resulting in hypovolemic shock eksanguinasi / anemia and cause urosepsis.
Estimates of Origin hematuri
The blood may come from different parts of kidneys, the glomeruli, tubules and interstisium or from the urinary tract, bladder and urethra. Red blood cells regardless of the glomerular capillaries through gaps in the capillary walls which can not be seen even with an electron microscope examination. Proteinuria, erythrocytes and erythrocyte piston which experienced deformity usually accompanies hematuria in urine from glomerular damage. Renal papillae can be damaged by microthrombi and / or anoxia in patients with hemoglobinopathy or toxin. Patients with renal parenchymal abnormalities may indicate the presence of microscopic or macroscopic hematuria during a systemic infection, or after moderate physical activity. It was as a result of renal hemodynamic response to physical activity or fever. It is important to distinguish between the cause of glomerular hematuria and non-glomerular in order to limit the possibility of diagnosis and direct a more focused examination.
