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Monday, 2 December 2013

Hemorrhaging: Hematuria - the Causes and Risk factors

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Hematuria
Hematuria is defined as a medical condition with the presence of blood in the urine.

C.1 Causes and Risk factors
C.1. Causes
1. According to to the study at the University of Texas Southwestern Medical Center at Dallas,  bladder cancer based on > or = 10 years of smoking or environmental exposure with microscopic hematuria are rarely evaluated thoroughly and only 12.8% were referred for urologic evaluation. Further studies are needed to evaluate both the utilization and effectiveness of guidelines for hematuria(1).

2. Kidney cancer
Tumor compresses onto capillary ot blood vessel can cause blood in the urine.

3. Inflammation 
In the study of 82 of 1209 patients (6.8%), follow-up evaluation was available for 43 of 85 (50.6%) findings by histologic diagnosis (n = 9), imaging evaluation (n = 31), or clinical information (n = 3). There were 11 (0.9%) examinations with acute findings, of which acute inflammation of the gastrointestinal tract and pancreaticobiliary system were the most common. Seventy-two (5.9%) examinations revealed 74 nonacute but important findings(2).

4. Sickle cell disease
There is a report of a case of recurrent gross hematuria, sickle cell trait and von Willebrand's disease is reported. The gross hematuria abated promptly after the institution of cryoprecipitate therapy(3).

5. Oral anticoagulation (OA)
Oral anticoagulation (OA) is a common treatment with a known risk of fatal or major bleeding, but also minor bleeding symptoms and menorrhagia can cause substantial discomfort and necessitate medical or surgical interventions(4).

6. Vigorous exercise
There is a report of during a 6-month Amphibious Task Force deployment to the Mediterranean Sea, five sailors and Marines were admitted to the ship's ward with severe upper extremity pain, elevated serum muscle enzymes, and a urinalysis dip positive for blood in the absence of microscopic hematuria-a finding highly suggestive of myoglobinuria(5).

7. Sexual activity
In the study to assess the relationship between sexual behaviour, urinary symptoms, urinalysis and bacteriuria in men attending STD clinics of 704 patients had had sexual intercourse (SI) within 14 days of testing, 424 had urinary symptoms and 122 had pyuria. All 13 patients with positive culture had SI < 14 days before testing, urinary symptoms and pyuria. No association was found between sexual orientation, type of SI, number of sexual partners, condom usage and bacteriuria(6).

8. Hemorrhagic cystitis 
In the study to evaluate the association between the prevalence of viral infections and hemorrhagic cystitis in pretransplant and posttransplant recipients and donors, showed that detection of single and multiple infections of BK virus, adenovirus, and cytomegalovirus in blood and/or urine samples of hematopoietic stem cell transplant recipients, in combination with 1 or more inducing factors of hemorrhagic cystitis were enforced on the important role these risk factors play in the cause of hemorrhagic cystitis(7).

9. Etc.

C.2. Risk factors 
1. Family history 
PKD1 gene abnormality is responsible for 85% of cases of ADPKD, patients with PKD2 mutations typically present later and progress more slowly. Patients with ADPKD can present with a positive family history, hypertension, flank pain, haematuria, renal insufficiency or proteinuria(8). 

2. Other risk factors
In the study to determine the prevalence of urological pathology in a retrospective and prospective study of patients with microscopic haematuria attending a haematuria clinic, between January 1998 and May 2001, 781 patients attended the haematuria clinic; of these, 368 (47%; median age 60 years, range 18-90) had a history of microscopic haematuria, as detected by urine dipstick testing, showed that Urine cytology showed no malignant cells in any patient with a history of microscopic haematuria. In 143 patients (39%), urine cytology showed no red blood cells and all other investigations were normal. Of the remaining 225 patients, IVU showed a tumour in one (bladder), renal stones in 15 and an enlarged prostate in two. Renal ultrasonography detected no additional pathology. Urine analysis showed one urinary tract infection. Flexible cystoscopy detected five patients with a bladder tumour (all G1pTa), two urethral strictures, five bladder stones and enlarged prostates, six enlarged prostates only, and nine red patches in the bladder, showing one patient with carcinoma in situ. No PSA levels were suggestive of prostate cancer(9).


3. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/20564400
(2) http://www.ncbi.nlm.nih.gov/pubmed/22915402
(3) http://www.ncbi.nlm.nih.gov/pubmed/313457 
(4) http://www.ncbi.nlm.nih.gov/pubmed/17260163
(5) http://www.ncbi.nlm.nih.gov/pubmed/7816216
(6) http://www.ncbi.nlm.nih.gov/pubmed/8976831
(7) http://www.ncbi.nlm.nih.gov/pubmed/22142049
(8) http://www.ncbi.nlm.nih.gov/pubmed/22497104
(9) http://www.ncbi.nlm.nih.gov/pubmed/12175388