Materiały źródłowe

• #1 Pathogenesis of glomerular haematuria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4419128/

  Haematuria was known as a benign hallmark of some glomerular diseases, but over the last decade, new evidences pointed its negative implications on kidney disease progression. […] The precise mechanisms responsible for haematuria remain unclear. The presence of red blood cells (RBCs) with irregular contours and shape in the urine indicates RBCs egression from the glomerular capillary into the urinary space. Therefore glomerular haematuria may be a marker of glomerular filtration barrier dysfunction or damage. […] Recent advances suggest that glomerular haematuria may be a negative prognostic factor for renal function outcome. A more fragile and easily ruptured glomerular filtration barrier (GFB) may be responsible for glomerular bleeding. Several factors have been associated to this pathogenic process, including: (1) genetic alteration of GFB components, leading to a more fragile and easily ruptured GFB structure; (2) aberrant deposition of toxic molecules in the GFB; and (3) enhanced inflammatory response, as reported in autoimmune diseases, infections, or primary glomerulonephritis.

• #1 Pathogenesis of glomerular haematuria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4419128/

  The presence of dysmorphic RBCs with irregular contours and shape in the urine is almost pathognomonic of glomerular haematuria and indicates RBCs egression from the glomerular capillary into the urinary space. Therefore glomerular haematuria is a marker of the GFB dysfunction or damage. […] It has been thought that under physiological conditions, the endothelium with its fenestrations (50-100 nm) acts as molecular size sieve, self-sufficient to maintain the RBCs (6.2-8.2 m) away from the GBM. However, haematuria in some diseases such as TBMN, Fibrillar deposit diseases or MYH9-associated kidney disease with typically intact endothelium, highlighted the key integrative role of GFB complex as a RBCs sieve. […] According to its primary and histopathologic localization the haematuric disorders may be classified into: (1) Glomerular endothelial cell and surface layer injuries; (2) primary and secondary GBM disorders; (3) Diseases with mesangial deposition; (4) Diseases with subendothelial and subepithelial deposition; (5) Podocyte-associated disorders; and (6) Miscellaneous.

• #1 Pathogenesis of glomerular haematuria

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4419128/

  The intrinsic pathogenical mechanism of glomerular haematuria remains unclear. Dysmorphic urinary RBCs pointed GFB dysfunction or damage as a possible alteration associated to this pathological process. Three possible pathological mechanisms may be implicated in GFB dysfunction and subsequent haematuria onset, including genetic alteration of GFB components, aberrant deposition of toxic molecules in the GFB, and an enhanced inflammatory response.

• #2 Isolated Hematuria – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/symptoms-of-genitourinary-disorders/isolated-hematuria

  Red blood cells (RBCs) may enter urine from anywhere along the urinary tract from the kidneys, collecting system and ureters, prostate, bladder, and urethra. […] Glomerular disorders can be a cause at all ages. Glomerular disorders may represent a primary renal disorder (acquired or hereditary) or be secondary to many causes, including infections (eg, group A beta-hemolytic streptococcal infection), systemic rheumatic diseases (eg, systemic lupus erythematosus [SLE], granulomatosis with polyangiitis, immunoglobulin Aassociated vasculitis [Henoch-Schnlein purpura] in children), and blood disorders (eg, mixed cryoglobulinemia, serum sickness). […] Presence of casts, protein, or dysmorphic RBCs (unusually shaped, with spicules, folding, and blebs) indicates a glomerular disorder.

• #3 Hematuria in Children | Ashraf | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/124/84

  RBCs in urine may originate from the renal tissue (glomeruli, renal tubules and interstitium), or urinary tract (collecting systems, ureters, bladder and urethra). […] In children, the source of bleeding is more often from glomeruli than from the urinary tract; however, distinction may be made by careful microscopy of the urine, with glomerular hematuria being characterized by deformed, misshapen RBCs. […] Erythrocyte dysmorphism is thought to result from deformation of the erythrocyte while it is passing through gaps of the glomerular basement membrane (GBM) followed by physicochemical insults occurring while the erythrocyte passes through the tubular system. […] The mechanism whereby hypercalciuria causes hematuria is unclear. It has been assumed either that hematuria is the result of irritation of the uroepithelium by microcalculi or that microscopic areas of nephrocalcinosis cause bleeding.

• #4 Hematuria pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hematuria_pathophysiology

  The pathophysiology of hematuria depends on the underlying etiology. It is understood that glomerular hematuria is caused by either the dysfunction or damage of the glomerular filtration barrier(GFB). Molecular defects (COL4A5, COL4A3/COL4A4, COL4A1, Non muscle myosin IIA heavy chain, Fibronectin, etc.) might be involved in the pathogenesis of glomerular hematuria. […] The pathophysiologic mechanism of glomerular hematuria might be further classified into 6 subtype depending on the primary and histopathologic localization. […] The pathophysiology of non-glomerular hematuria might be depending on the underlying etiology. It is thought that non-glomerular hematuria is caused by either polycystic kidney disease, sickle cell disease and papillary necrosis, nephrolithiasis, trauma, leukemia, tumors, strenuous exercise, or infection.

• #5

  https://link.springer.com/article/10.1007/BF02889902

  Masugi nehpritis was induced in Sprague-Dawley rats by an intravenous injection of rabbit anti-rat kidney serum. In the autologous phase of the disease, three of 18 rats manifested continuous hematuria. Ultrastructural examination of renal glomeruli by transmission and scanning microscopy revealed gaps in the basement membranes, and the transcapillary passage of red blood cells through the discontinuous regions in the hematuric rats. Control animals revealed no gaps in the glomerular basement membranes regardless of the method used in their preparation for electron microscopy. These data support the hypothesis that hematuria is a result of the passage of red blood cells through gaps in the glomerular basement membrane in Masugi nephritis.

• #6 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Causes-of-Blood-in-Urine.aspx

  Blood seen in the urine arises from somewhere in the urinary tract, which is made up of the bladder, kidneys, ureters and urethra. […] Kidney disease often causes microscopic hematuria. The blood-filtering units of the kidney called glomeruli become inflamed. Examples of conditions that can cause kidney disease include diabetes, vasculitis, viral infection and certain immune disorders that affect the glomeruli. Accidents that result in injury to the kidney can also cause blood to be passed in the urine. […] Inherited conditions such as sickle cell anemia (due to defective hemoglobin in erythrocytes) and Alport syndrome (abnormality of the glomerular filtering membrane) can cause both macroscopic and microsopic hematuria. […] Some drugs such as the antibiotic penicillin and the anticancer therapeutic cyclophosphamide can cause hematuria. If a person already has a condition that causes the bladder to bleed, then the use of anticoagulants such as aspirin or heparin may also lead to macroscopic hematuria.

• #7 Hematuria – Signs and Symptoms – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.I.1.18.

  Hematuria is defined as an increased number of red blood cells (RBCs) in urine, namely, 3 RBCs per high-power field (HPF) in a centrifuged urine sample. […] Causes of hematuria: The following classification is based on the origin of RBCs in the urinary tract: 1) Glomerular hematuria (caused by glomerular disease): All types of acute or chronic glomerulonephritis, including IgA nephropathy, antiglomerular basement membrane disease, and immune complex glomerulonephritis; hereditary causes, such as Alport syndrome; and benign causes, such as thin basement membrane disease. […] Nonglomerular hematuria accounts for ~90% of all cases of hematuria.

• #8 Hematuria | Urine Analysis, Kidney Disease & Blood Cells | Britannica

  https://www.britannica.com/science/hematuria

  hematuria, presence of blood in the urine, an indication of injury or disease of the kidney or some other structure of the urinary tract; in males blood in the urine can also come from the reproductive tract. The blood may become apparent during urination or only upon microscopic examination. […] Blood in the urine ordinarily comes from the urethra, the bladder, or the kidneys. When the urethra is involved, the blood appears at the start of urination and is bright red. The urethra may bleed because of physical injuries, obstructions, infections, or strictures (abnormally narrow sections). Blood coming from the bladder may contain clots and usually appears toward the end of urination. Such bleeding is usually caused by stones or tumours in the bladder. […] Renal (kidney) bleeding can be produced by a number of disorders, including ruptured blood vessels, tumours, renal obstructions, kidney stones, chemical irritants (e.g., carbon tetrachloride, lead compounds, and ethylene glycol), and infections and inflammation of the kidney (e.g., Brights disease, pyelonephritis). In some cases there may be excessive bleeding from the kidneys with no apparent cause. Hematuria unaccompanied by pain is ordinarily regarded as due to a tumour in the urinary tract until proved otherwise.

• #9 Urine – bloody : MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003138.htm

  Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the blood is visible. It often turns the toilet water red or pink. Or, you may see spots of blood in the water after urinating. […] There are many possible causes of blood in the urine. Bloody urine may be due to a problem in your kidneys or other parts of the urinary tract, such as: Cancer of the bladder or kidney, Infection of the bladder, kidney, prostate, or urethra, Inflammation of the bladder, urethra, prostate, or kidney (glomerulonephritis), Injury to the bladder or kidney, Kidney or bladder stones, Kidney disease after strep throat (post-streptococcal glomerulonephritis), a common cause of blood in the urine in children, Kidney failure, Polycystic kidney disease, Recent urinary tract procedure such as catheterization, circumcision, surgery, or kidney biopsy.

• #10 Hematuria – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hematuria/

  Hematuria is the presence of 3 red blood cells (RBCs) per high-power field (HPF) in the urine. It is often classified by visibility and origin. Glomerular hematuria originates from glomerular damage. Causes include glomerulonephritis (GN), e.g., IgA nephropathy or thin basement membrane disease. It is characterized by dysmorphic red blood cells observed on urine microscopy. Nonglomerular hematuria results from urothelial damage (e.g., nephrolithiasis, malignancy, cystitis, trauma), or tubulointerstitial disease (e.g., renal papillary necrosis, interstitial nephritis) and is characterized by normal RBC morphology on urine microscopy. The underlying cause is determined through further evaluation, e.g., urinalysis (UA) and imaging, and guides the appropriate management. […] Macroscopic hematuria in adults is most commonly caused by nephrolithiasis, UTI/pyelonephritis, BPH, or malignancy. […] Dysmorphic RBCs, RBC casts, and/or significant proteinuria on urine microscopy suggest a glomerulopathy. […] Diagnosis of glomerular disease does not rule out urinary tract malignancy. […] Older age, male sex, and smoking are the main risk factors for urinary tract cancer.

• #11 Gross and Microscopic Hematuria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534213/

  Hematuria may result from structural alterations due to an injury, infection, or a mass anywhere in the genitourinary tract. Anticoagulation alone does not cause hematuria but may exacerbate this symptom. Patients on anticoagulants or antiplatelet therapy should receive the same evaluation as individuals not on such agents, as their risk of malignancy is the same. Immunological or inflammatory processes may damage the integrity of the renal glomerular basement membrane, mesangium, or microvascular endothelium. This usually presents as glomerular bleeding. […] Nonglomerular causes of bleeding, including nephrolithiasis, urolithiasis, certain drugs, nephrocalcinosis, genitourinary neoplasms, trauma-related urothelial mucosal damage, catheterization, urological biopsies or similar procedures, benign prostatic hyperplasia, radiation exposure, and various chemicals may cause erosion or otherwise damage the urothelial surface somewhere in the urinary tract, leading to hematuria.

• #12 Blood in Urine: 15 Causes Affecting Males

  https://www.verywellhealth.com/hematuria-blood-in-urine-possible-causes-in-men-2328356

  Blood in urine (hematuria) in males has many causes, including an enlarged prostate, urinary tract infection, kidney stones, and injury. […] Hematuria may be visible to the naked eye or only be detected with urine tests. […] While the cause is often benign (not harmful), blood in the urine should never be ignored as it may be a sign of a serious medical condition, cancer included. […] Urinary tract infection (UTI) is the most common cause of hematuria, particularly infections of the bladder. […] Hematuria occurs in at least 88% of cases of urogenital trauma. […] Symptoms of a kidney injury may include hematuria as well as: […] While having a large amount of blood in the urine is more frequently associated with major injuries, it is possible to have a major injury with only a small amount of blood in the urine.

• #12 Blood in Urine: 15 Causes Affecting Males

  https://www.verywellhealth.com/hematuria-blood-in-urine-possible-causes-in-men-2328356

  Other possible causes of blood in urine in males include: […] There are several rare diseases and genetic disorders that can cause blood in the urine: […] The treatment of hematuria is directed by the underlying cause. […] Medications that cause hematuria may also need to be substituted or have their dose adjusted. […] Blood in the urine (hematuria) is common in males. […] It is frequently caused by conditions like an enlarged prostate, urinary tract infections, epididymitis, orchitis, bladder or kidney stones, bladder or kidney infections, and certain medications. […] Less common causes include glomerulonephritis, lupus, genetic disorders like sickle cell anemia, and cancers like bladder cancer, kidney cancer, and prostate cancer. […] Hematuria is diagnosed with a physical exam, a review of your medical history, and urine- and blood-based tests. […] The treatment of hematuria is directed by the underlying cause.

• #13 Blood in Urine: Causes, Treatment, Diagnosis & More

  https://www.healthline.com/health/urine-bloody

  Different conditions and diseases can cause hematuria, which is the medical term for blood in your urine. […] Any blood in the urine can be a sign of a serious health problem, even if it happens only once. […] Ignoring hematuria can lead to the worsening of serious conditions like cancer and kidney disease, so you should talk to your doctor as soon as possible. […] Infection is one of the most common causes of hematuria. […] The infection could be somewhere in your urinary tract, your bladder, or in your kidneys. […] Infection occurs when bacteria move up the urethra, the tube that carries urine out of the body from the bladder. […] Another common reason for blood in the urine is the presence of stones in the bladder or kidney. […] A less common reason for seeing blood in the urine is kidney disease.

• #14 Medical Student Curriculum: Hematuria – American Urological Association

  https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/hematuria

  Nonglomerular etiologies can be subdivided by location: the upper urinary tract (kidney and ureter) or the lower urinary tract (bladder and urethra). The more commonly encountered upper and lower urinary tract etiologies are listed in Table 3. Although urothelial carcinoma involving the urinary bladder is the most common malignancy discovered in patients with asymptomatic microhematuria, benign processes are far more common than cancer. […] Oral anticoagulation therapy does not lead to de novo hematuria. However, the degree and duration of hematuria from another cause may be influenced by such therapy. […] The differential for hematuria is broad and includes glomerular and non-glomerular etiologies, the latter of which can be divided into upper and lower urinary tract origins. […] A complete urologic workup for hematuria includes cystoscopy and imaging of the upper urinary tracts.

• #15 Hematuria: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/981898-overview

  Hematuria is one of the most common urinary findings that result in children presenting to pediatric nephrologists. Generally, hematuria is defined as the presence of 5 or more RBCs per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. Hematuria can be gross (ie, the urine is overtly bloody, smoky, or tea colored) or microscopic. It may be symptomatic or asymptomatic, transient or persistent, and either isolated or associated with proteinuria and other urinary abnormalities. […] The etiology and pathophysiology of hematuria vary. For instance, hematuria of glomerular origin may be the result of a structural disruption in the integrity of the glomerular basement membrane caused by inflammatory or immunologic processes. Chemicals may cause toxic disruptions of the renal tubules, whereas calculi may cause mechanical erosion of mucosal surfaces in the genitourinary tract, resulting in hematuria.

• #16 Hematuria | Center for Urologic Care of Berks County

  https://www.centerforurologiccare.com/patient-education/hematuria/

  Hematuria is a term used to describe a condition characterized by blood in the urine. […] Both microscopic and macroscopic hematuria are consequences of entirely different pathologies. […] The damage to any structure throughout the urinary tract can cause hematuria. […] Hematuria is not a disease, but rather a sign of an underlying pathology. […] The most crucial concern is to rule out cancer in these patients. […] Infection in any part of the urinary tract, including the kidneys, results in inflammation (bodys natural reaction to injury) and ultimately damage to surrounding tissue. This also includes surrounding vessels, allowing blood passage through leaky vessels into the urinary tract, manifesting as blood in the urine. […] The direct impact of stone on lining cells of the urinary tract results in destruction, ultimately allowing blood to leak into urine.

• #17 Glomerular Hematuria: Cause or Consequence of Renal Inflammation?

  https://www.mdpi.com/1422-0067/20/9/2205

  Glomerular hematuria is a cardinal symptom of renal disease. Glomerular hematuria may be classified as microhematuria or macrohematuria according to the number of red blood cells in urine. Recent evidence suggests a pathological role of persistent glomerular microhematuria in the progression of renal disease. Moreover, gross hematuria, or macrohematuria, promotes acute kidney injury (AKI), with subsequent impairment of renal function in a high proportion of patients. In this pathological context, hemoglobin, heme, or iron released from red blood cells in the urinary space may cause direct tubular cell injury, oxidative stress, pro-inflammatory cytokine production, and further monocyte/macrophage recruitment. […] Although hematuria is a cardinal symptom of renal disease, it has occupied very little relevance as a negative prognostic factor, unlike proteinuria that continues to play a central role in the diagnosis and treatment of kidney diseases. This lack of interest in hematuria is surprising because it is a defining symptom of IgAN and other pathologies. New evidence suggests a link between inflammation and the genesis of glomerular hematuria.

• #17 Glomerular Hematuria: Cause or Consequence of Renal Inflammation?

  https://www.mdpi.com/1422-0067/20/9/2205

  Renal findings in pathologies related to glomerular hematuria usually include tubules filled with RBC casts and acute tubular necrosis, mainly during the gross hematuria bouts. Massive hematuria of glomerular origin produces AKI and damage in tubular cells through different mechanisms: (a) direct tubular damage due to intratubular obstruction of the blood casts, (b) direct tubular toxic effect of hemoglobin (Hb) and heme produced after rupture of the erythrocytes in the tubular lumen, and (c) processes of erythrophagocytosis by the renal tubular cells. […] For many years, hematuria has been considered as only a symptom of some renal disorders. However, multiple studies have challenged this concept, pointing out that the presence of hematuria is associated with an increased risk of developing end-stage renal disease (ESRD). Glomerular diseases, specially IgAN, constitute the scenario where the association between hematuria and long-term renal dysfunction have been best analyzed. In this way, the persistence of hematuria in IgAN has been related to a greater probability of developing ESRD compared to patients with minimal or negative hematuria.

• #17 Glomerular Hematuria: Cause or Consequence of Renal Inflammation?

  https://www.mdpi.com/1422-0067/20/9/2205

  Hematuria is a common urinary finding present in several glomerular diseases and patients with bad control of coagulation, among other conditions. Recent studies indicate a pathological role of hematuria in renal damage by promoting AKI and progression to CKD. The renal damage mediated by hematuria is related to nephrotoxic actions of Hb and heme on tubular cells, although data from our studies may suggest that the podocyte may be another cellular target of these molecules. Inflammation and oxidative stress are key processes involved in hematuria-related diseases, and may be plausible targets to develop novel therapeutic approaches.

• #18 Blood in Urine: When to Be Concerned & What to Know

  https://www.cancercenter.com/community/blog/2022/09/when-to-worry-about-blood-in-urine

  Blood in the urine, clinically known as hematuria, is caused when red blood cells from the kidneys, ureters, bladder or urethra have entered the urine stream. […] Is blood in the urine always cancer? No. But cancer is always a concern with painless, gross hematuria, says Dr. Sadeghi. And thats why it must be properly evaluated. […] The most common cancers that may produce blood in the urine include: Bladder cancer, Kidney cancer, Prostate cancer. […] In most cases, hematuria is the first sign of bladder cancer. […] Blood in the urineusually appearing as rusty or dark redis the most common symptom of kidney cancer. […] Blood may also appear in the urine of patients with advanced prostate cancer. […] Because of the concern about a possible cancer diagnosis, hematuria, especially the painless kind you can see, must always be taken seriously, Dr. Sadeghi says.

• #19 UTI or Cancer: What To Know About Blood in the Urine | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/news/uti-cancer-what-know-about-blood-urine

  Blood in the urine, also called hematuria, is a sure sign that something is wrong. […] Blood in the urine can be a sign of infection, kidney stones, or cancer, especially bladder cancer. […] A tumor may grow, and the blood vessels within it become fragile so that they rupture and bleed, Dr. Pietzak says. […] Blood in the urine is more likely to be cancer in men than in women, mainly because men develop bladder cancer at a much higher rate about four times as much than women. […] If no UTI is detected, the doctor may do a test called a urine cytology, which checks for cancer cells. […] If it comes back positive or suspicious for cancer cells in the urine, that is very concerning, Dr. Pietzak says. […] This includes looking at mutations in urine to make it easier to diagnose what’s happening including whether the blood in the urine is from cancer or another cause.

• #20 EXERCISE-INDUCED HEMATURIA | Sports Medicine Today

  https://www.sportsmedtoday.com/exerciseinduced-hematuria-va-116.htm

  Exercise-induced hematuria is a benign condition in which blood is present in the urine (hematuria) following exercise. […] In general, if the urine clears 72 hours after exercise, there is no need to further investigate. […] However, some causes do need to be investigated, particularly if the blood in the urine keeps appearing, or does not clear after 72 hours. […] For most cases of exercise-induced hematuria, the causes are related to the intensity and duration of activity, as well as the hydration status of the athlete. […] Hematuria in itself can be caused by other factors apart from exercise, such as urinary tract infections, the presence of a stone in the urinary tract, kidney disease, among others; athletes with such conditions may be at higher risk of exhibiting blood in their urine after exercise.

• #20 EXERCISE-INDUCED HEMATURIA | Sports Medicine Today

  https://www.sportsmedtoday.com/exerciseinduced-hematuria-va-116.htm

  Evaluation of a urine sample is needed to investigate hematuria. […] In cases where there is no trauma, exercise-induced hematuria usually resolves within 24-72 hours of rest after the athletic event. […] If hematuria persists longer than 72 hours or continues to occur with strenuous exercise, further investigation may be needed.

• #21 Blood in Urine Specialist Miami | Gross Hematuria | Urologist Miami

  https://www.miamiurologyconsultants.com/gross-hematuria-blood-in-the-urine.html

  Gross or microscopic hematuria can occur secondary to bleeding from cancer of the inner lining of the bladder, ureters, or kidneys known as transitional cell carcinoma. […] Sickle cell anemia, a disease affecting hemoglobin in red blood cells can cause hematuria. […] Any traumatic event whether penetrating or blunt can cause gross or microscopic hematuria. […] Certain medications can cause gross or microscopic hematuria. […] Although not common, with strenuous exercise a small proportion of individuals will begin to see blood in the urine. […] Risk factors for hematuria include the same risk factors associated with the conditions that cause the hematuria. […] Work up with cystoscopy for hematuria is typically done in the urologist’s office. […] Depending on the degree of severity and the risk factors of a patient, a renal ultrasound, CT scan, or MRI is used. […] A urinalysis can be helpful for quantifying the number of red blood cells in the event of microscopic hematuria. […] The treatment for blood in the urine of course depends fully on the cause.

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