Causes of elevated red blood cells in the urine

Laboratory test results often raise many questions for patients. This is especially the case when blood elements appear in fluids, where they normally should not be - for example, if red blood cells are found in the urine. Such a condition is called erythrocyturia and is one of the variants of hematuria.

The term " hematuria " literally translates as "blood in the urine," and means the presence of not only red blood cells, but also other blood elements. That is why erythrocyturia is designated by a separate term. Does he indicate serious health problems?

What does it mean?

Red blood cells are responsible for the transport of oxygen, and their rate in the urine is no more than three or four in the field of vision. Excess of this norm is called erythrocyturia, or hematuria (if, in addition to erythrocytes, other components or blood cells are found in the urine).

A common factor that contributes to the appearance of such a problem is the infectious process in the urinary tract, or the tumor process. But a correct diagnosis can be made only after a cumulative assessment of the results of laboratory tests, instrumental diagnostics, as well as information obtained in the course of studying the patient’s medical history.

The presence of a large number of red blood cells in the urine often provoke mechanical damage, such as injury. In women, blood can enter the urine during menstruation.

In healthy people, urinalysis does not reveal red blood cells at all, or 1-2 microscopic examination.

If more than one or two erythrocytes are detected in the morning uric fluid, the doctor may prescribe an additional analysis - for example, urine collection according to Nechyporenko.

The norm of red blood cells in the analysis of urine according to Nechyporenko - not more than 1000 / ml. A greater number of them allows to suspect pathologies such as the presence of stones in the kidneys or urea, polyposis, tumor processes, purulent form of cystitis, heart disease, hypovitaminosis C, systemic lupus erythematosus, etc. And on indicators obtained during other diagnostic activities.

Causes of red blood cells in the urine

Red blood cells are blood cell structures that deliver oxygen to the tissues of the body. According to the theory, they generally should not be in the composition of urine. Nevertheless, as practice shows, a small number of these cells sometimes comes into view. This is due to a slight leakage of red blood cells through the membrane of the kidneys or vascular walls. If this number exceeds the norm, then we can think of both the onset of the inflammatory reaction in the urinary apparatus or the kidneys, as well as traumatic injuries, neoplastic processes, and stones.

If renal function is impaired, red blood cells in the urine are found in pyelonephritis, amyloidosis, glomerulosclerosis, nephropathy, glomerulonephritis.

Glomerulonephritis often causes patients to see a doctor: an acute form of the disease begins with pain, increased urination, changes in the color of the urinary fluid. Only after the analysis of urine is detected the presence of red blood cells in it.

Cystitis, urinary diathesis, tumors, mechanical damage (for example, after some medical manipulations) often become the cause of erythrocyturia in the pathology of the urinary apparatus.

Stones in the kidneys or in the bladder can injure the mucous membrane of the urinary system from the inside, which can also cause red blood cells to appear in the urine. Most often this is observed during an attack of movement of the stones, but in some cases it is possible erythrocyturia and outside the period of exacerbation. It happened that even sand in the kidneys led to microhematuria: it all depends on the component composition of the stones, on the size and shape of the grains of sand, as well as on the general condition of the kidneys and urinary apparatus.

In the course of treatment with nonsteroidal anti-inflammatory drugs, sulfa drugs, glucocorticoids, as well as after antibiotics in the urine, erythrocytes can also be detected. Especially often this happens after a course of treatment with aminoquinolines - for example, Chloroquine, Delagil. In most cases, this is due to increased permeability of the vascular walls, the development of post-drug vasculitis.

In some cases, the problem may arise when injecting fluids for oral dehydration. For example, erythrocytes in the urine after rehydron may appear with impaired renal function, or if the drug was administered too quickly.

With prostatitis, red blood cells in the urine are relatively rare, and this is considered an indirect sign of the onset of complications. So, perhaps an inflammatory violation of the structure of the gland with damage to a part of the blood vessel, or hyperplasia, or a malignant tumor process. The exact cause must be established by the doctor.

In women, during menstrual bleeding and even before menstruation, blood elements can get into the urinary fluid during its collection, if special rules have not been followed. In general, closer to the beginning of menstruation, it is not recommended to take a urine test at all, since the results obtained as a result may be significantly distorted. But there are cases when the analysis is required to pass urgently. Then you have to follow these rules:

• conduct high-quality washing;
• insert a vaginal swab to avoid blood ingress into urine;
• start urination, collecting only the middle portion of urine in a sterile container.

In order to avoid mistakes, it is recommended to repeat the test once a few days after the end of the monthly bleeding.

As for tumors, they are able to appear in any organ of the genitourinary apparatus. The leading symptom, which allows to suspect a tumor process, is the detection of blood elements, and in particular, red blood cells in the urine. In cancer, hematuria can be either pronounced or hidden, it can periodically appear and disappear. In such a situation, it is very important to perform a cystoscopy in time to determine the source of the bleeding.

[1], [2], [3], [4], [5], [6]

Risk factors

Often, medical professionals mention factors that increase the risk of developing a disease. There are such factors in terms of the appearance of red blood cells in the urine.

• Age factor and gender. The dangers are predominantly men over fifty years of age (primarily due to the frequent complications of prostate diseases).
• Recently transferred infectious disease. Viral and bacterial infections increase the likelihood of kidney complications, and, as a result, red blood cells may appear in the urine.
• Hereditary predisposition There are "family" history of diseases associated with urolithiasis or renal pathologies.
• Regular medication, self-healing propensity. Many antibiotics (for example, penicillin), nonsteroidal anti-inflammatory, and other drugs can increase the risk of red blood cells in the urine.
• Excessive physical activity. Physical activity, especially prolonged, can contribute to a change in urine analysis: for example, long-distance runners are characterized by microhematuria.

[7], [8], [9]

Pathogenesis

Consider the main pathogenetic factors of the appearance of erythrocytes in the urine:

• Mechanical damage, destruction of urinary apparatus tissues (cancer process, abscess, necropapillitis, tuberculosis).
• Increased pressure in the renal vein (the formation of a blood clot in the renal veins).
• Violation of the integrity of the basement membrane (immune or metabolic etiology of damage - for example, in glomerulonephritis, renal amyloidosis, diabetic glomerulosclerosis).
• Coagulating processes inside the renal vessels (with periarteritis nodosa, lupus nephritis, thrombocytopenic purpura, hemolytic-uremic syndrome),
• Congenital disorder of the glomerular basement membrane (for example, in Allport syndrome).
• Toxic or inflammatory interstitial reaction (with interstitial nephritis, hemorrhagic fever against the background of renal syndrome).

Pathologically, the appearance of erythrocytes in the urine may be accompanied by inflammatory processes, deposition of amyloid masses, thickening of the glomerular basement membrane, or its specific changes, expansion of the mesangium.

[10], [11], [12], [13], [14], [15], [16]