Transcription
Hey guys, it's Medicosa's Perfect Snail, where medicine makes perfect sense. Let's continue our Labs playlist.
In previous videos, we talked about beta-2 microglobulin, Benz Jones proteins, urine electrophoresis, uric acid, urine chloride, urine potassium, urine osmolarity, and the urine anion gap. In this playlist, we have discussed urine culture and sensitivity, urine leukocyte esterase, urine nitrites, as well as the microscopic examination of the urine. Today, let's talk about blood in the urine: hematuria. Hemato means blood, and urea means urine.
Before we start, can you close your eyes and enumerate eight causes of hematuria? Please watch the videos in this playlist in order. A normal kidney is a kidney that does not let protein or blood in the urine. A kidney with nephrotic syndrome lets protein in the urine. A kidney with nephritic syndrome—itis means inflammation—is an inflamed kidney that is shedding tears of blood in the urine: hematuria.
If you want to know about all the subtypes of nephrotic syndrome and nephritic syndrome, check out my Nephrology playlist. Between these two, which one is more likely to cause hematuria? Nephritic syndrome, of course, which includes acute post-streptococcal glomerulonephritis, crescentic or rapidly progressive glomerulonephritis. Oh, by the way, lupus and Goodpasture syndrome are here. Don't forget IgA nephropathy, as well as Alport syndrome, plus diffuse proliferative glomerulonephritis and membranoproliferative glomerulonephritis. When you see "-itis," it means "-itis," it means blood; the kidney is inflamed and shedding tears of blood.
Not everything that shines is gold, and not every red urine is actually blood; sometimes it's just a pigment. If you eat too much beets, you will have red urine, but these are not red blood cells; it's just a pigment. If I exercise too much, like running a marathon while being dehydrated, I can get myoglobinuria; that's not blood, that's myoglobin in the urine. Also, hemoglobin in the urine is not actually red blood cells. For me to say this is actually a true hematuria, I need the urine dipstick test to be positive, and I need to actually see real red blood cells in the urine. That's where I know that this is actually a true hematuria.
But where's the blood coming from? Is it coming from the bladder or the urethra, or is it coming from something above, like the kidney? To tell the difference, look for urine casts. If you see casts, blame the kidney. If you see no casts, it's coming from below the kidney, such as the bladder or the urethra.
If you have watched my previous video on microscopic examination of the urine, I've told you before that having zero red blood cells in the urine or one red blood cell in the urine is okay. More than three, and that's a problem. This is called true microscopic hematuria. When you say more than five white blood cells, this is probably an infection. When you see crystals, it means that kidney stones are imminent. And when you see casts, you blame the tubules, because when I see ice cubes, I can tell the shape of the container. If the ice is shaped like a cube, then I know that the container was shaped like cubes. By the same token, if you see casts in the urine, they look something like this; they took the shape of the kidney tubules, so I know that whatever disaster this is is coming from the kidney tubule. So if we see no casts, the problem is under the kidney, maybe in the urinary bladder, or maybe in the urethra. But if we see casts, we blame the kidney tubule. If you see this more for credible cells, this is also the kidney's fault, usually not the tubule, usually the glomerulus. Also, when you see elevated beta-2 microglobulin in the urine, which we have talked about before, it points more towards a tubular disease.
We can divide hematuria, or blood in the urine, into two types: gross hematuria or frank hematuria. This is blood that I can see with my naked eye. And microscopic hematuria; these are, let's say, five red blood cells in the urine. I could not see red blood with my naked eye; however, under the microscope, I saw red blood cells.
So what's the cause of this true hematuria? Anyonephritic syndrome, basically "-itis," glomerulonephritis, lupus nephritis, interstitial nephritis. Maybe there is a tumor in the kidney or in the ureter or in the bladder; maybe there is kidney cancer or bladder cancer. Maybe this patient has schistosomiasis or bilharziasis, such as Schistosoma haematobium infection; it can damage the urinary bladder big time. So after you finish your "-itis," look at your tumors and trauma; trauma to the kidney, trauma to the bladder, or trauma to the urethra. As you know, trauma can lead to hematoma. After this, kidney stones, urine tract infections, prostatitis, or inflammation of the prostate glands. Maybe there is infarction of the kidney; maybe there is the severe, also known as malignant hypertension. Malignant here does not mean cancer; it means severe. Maybe I have sickle cell anemia, which leads to vaso-occlusive crises, or maybe I have vasculitis.
This was the topic of hematuria. If you want to learn about pyuria, check out my video with this title in my playlist called Labs. If you want more topics in urology, such as testicular torsion, acute epididymitis, the interesting phenomenon of low implantation of the ureter, if you want to learn about bacterial prostatitis, acute obstructive pyelonephritis, which is a freaking emergency, posterior urethral valves, ureteropelvic junction obstruction, hypospadias, epispadias, and even urological tumors, download my Surgery High Yields course at medicosisperfectsnetis.com today.
After I told you about blood in the urine, but what about bleeding coming out of the vaginal canal? To learn about that, download my OB/GYN High Yields course. It will also teach you about infections such as endometritis, pelvic inflammatory disease, urinary tract infections, and asymptomatic bacteriuria, which is a big deal during pregnancy. Urinary tract infections can lead to pyuria and hematuria in some cases. How do we treat them? Antibiotics. You can use nitrofurantoin, trimethoprim-sulfamethoxazole, amoxicillin, fluoroquinolones, and even ceftriaxone. Learn about all these antibiotics by downloading my Antibiotics course at medicosisperfectsnetis.com.
Thank you for watching. Please subscribe, hit the bell, and click on the join button. It can support me here or here. Go to my website to download my courses. Be safe, stay happy, study hard. This is Medicosa's Perfect Snail, where medicine makes perfect sense.