Causes of red urine color

Urine or urine is a liquid excrement (excrementum), a product of a complex biochemical process (filtration, resorption, tubular secretion). Urine has quantitative and qualitative parameters that allow us to judge the health of the entire urinary system. One of the qualitative indicators of urine in a row with density, odor, presence of sediment, transparency and acidity is its color. The norm is considered to be a yellow tint, urine of red color is a clear deviation from normal indicators, caused by pathological, physiological or temporary, transient reasons.

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Cause

Urine coloring in an unusual color, color change is a visible indicator of the impact of various factors on the renal system. Such a sign in clinical urology and nephrology is usually called hematuria. The causes of red urine can be associated with diseases, but in some cases they can also be explained by factors associated with physical activity, dietary habits or taking medications.

The color of urine depends on the process of catabolism (dissimilatio) of hemoglobin, as a result of which specific pigments are produced. The concentration and type of pigment are influenced by external and internal factors:

• Age indicator.
• Ambient temperature.
• Environmental factors.
• Specifics of the food assortment.
• A course of treatment with medication.
• Water balance of the body, fluid intake regime.
• Physical activity and stress on the body (Montenbaker's hematuria).
• Congenital or acquired diseases.
• Specificity of metabolism.
• Pregnancy.
• Injuries, bruises.
• Genetic diseases.

Basic reasons for red urine:

1. Permeability of capillaries of the glomerulus of nephrons.
2. Thickening of the glomerular basement membrane.
3. Intravascular destruction of blood cells, hemolysis.
4. Inflammation of the t. interstitialis of the kidney (interstitial tissue).

Classification of hematuria by intensity of the process:

1. Erythrocyturia can only be detected by laboratory testing of urine. Microhematuria.
2. Red urine (various shades) is clearly visible as a clinical sign. Macrohematuria.

Based on the specifics of its manifestation and organ damage, hematuria is divided into the following categories:

1. Physiological haematuria or false hematuria, not associated with pathologies of the urinary system.
2. Orthostatic haematuria.
3. Haematuria renalis (renal hematuria).
4. Haematuria postrenalis (postrenal hematuria), a lesion of the lower urinary tract.

Changes in urine during hematuria are also divided into types that indicate the etiological factor:

1. Haematuria isolated, when urine analysis does not show critical deviations from the norm on the part of protein. The isolated process most often occurs in the area from the urethra to the pelvis renalis (from the urethra to the renal pelvis). These can be injuries, prostatitis (prostatitis), anemia (anemia), nephrolithiasis, tuberculosis of the kidney, oncological process in the organs of the urinary system
2. Haematuria in combination with an increased level of protein in the urine (proteinuria), with pyuria (leukocyturia), with cylindruria (detection of protein sediment elements in the urine).

According to the course of the process, hematuria is differentiated as follows:

1. Initial haematuria (red urine is visible in the first portion of urination).
2. Haematuria terminalis (terminal) - urine is colored at the end of urination.
3. Haematuria totalis (total) – uniform coloration of urine, release of erythrocytes throughout the entire act of urination.

Let's take a closer look at the causes of red urine, dividing them into two large groups:

1. Physiological factors associated with the process of digestion and excretion:
   • Food containing natural dyes can give urine a color from greenish-yellow to red or pink. Beets give urine a characteristic color due to the dye betacyan, which in turn helps to cope with cardiovascular diseases. Anthocyanins contained in red and purple berries can also change the color of urine from pale pink to dark burgundy. Blueberries, dark grapes and its derivative - wine, red or black currants, cherries, strawberries and the leader of the list - blackberries, passing through the gastrointestinal tract, color urine quite intensely depending on the acidity level of gastric juice (the lower the acidity of the environment, the brighter the color).
   • Medicines - aspirin (Acetylsalicylic acid) and all salicylates, NSAIDs - amidopyrine (Aminophenazonum), Milgamma, sulfonamides, diuretics, Methyldopa, Phenacetin, Phenolphthalein, nitrimidazoles, Rifampicin, Paracetamol, drugs containing anthraglycosides (anthraglycosides), nalidixic acid, some anesthetics (Propofol), Metronidazole, tetracyclines, cytostatics (Rubomycin) affect color urinae - the color of urine towards the red spectrum.
   • Pregnancy. Urine of red or pink color during pregnancy may be associated with increased work of the kidneys, which bear a double load, or with the peculiarities of the woman's diet. If, in addition to a temporary (24 hours) change in urine color, there are no other clinical manifestations and discomfort signs, such a phenomenon can be considered a transient physiological condition.
   • Infancy. During the first 10-14 days, newborns are allowed and considered normal to have a changed urine color, having a pale pink, red tint. This can be explained by purely physiological factors - active exchange of organic purine compounds, increased levels of uric acid.
   • Increased physical activity, training that affects muscle structure. Muscle striated fibers are damaged and secrete a specific protein - myoglobin, myoglobinuria develops, the color of urine changes towards red shades.
   • Intoxication with mercury vapor and lead.
   • Red urine may occur during the menstrual cycle.
   • Medical urological procedures (catheterization) can also cause red urine.
   • Thrombosis of hemorrhoidal rectal veins (hemorrhoids) is often a factor affecting the color of urine. A differential sign is the simultaneous coloring of feces in a red tint.
2. Pathological causes of red urine:
   • Micro or macrohematuria (blood, presence of blood cells in urine). The causes of red urine with hematuria are as varied as its types - initial, false, total, terminal.

Hematuria is a symptom. It is provoked by diseases in acute or chronic form related to the organs of the urinary system, and other pathologies:

• cystitis (cystitis);
• nephrolithiasis ( urolithiasis );
• pyelonephritis;
• nephritis ( nephritis );
• tumor process;
• hereditary nephritis ( Alport syndrome );
• cyst or polycystic kidney tissue;
• glomerular nephritis (glomerulonephritis);
• diabetes-related nephropathy;
• urethritis;
• arteriovenous malformations (pathological proliferation of blood vessels in kidney tissue);
• hypernephroid cancer;
• balanytis (balanitis);
• urogenital schistosomiasis;
• infective endocarditis, which may be accompanied by hematuria;
• hereditary pathology - Osler syndrome;
• hemolytic anemia;
• collagenoses;
• arthropathy;
• ankylosing spondylitis;
• psoriasis;
• systemic vasculitis;
• gout;
• endometriosis of the bladder;
• aorto-mesenteric pincer syndrome (nutcracker syndrome).

If the change in urine color is not caused by transient physiological factors, the causes of red urine require a thorough examination, differential diagnosis and treatment of the underlying disease.

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Diseases that cause red urine

Pathological causes of red urine are associated with hematuria, which in turn is considered one of the leading signs in the clinical picture of many nephropathologies. Diseases that cause the release of red urine are etiological factors for the appearance of erythrocytes or other formed elements of the bloodstream in the blood. Therefore, hematuria is classified as follows:

• Erythrocyturia (red blood cells in the urine).
• Hemoglobin cylindruria (pigment casts in the urine).
• Hemoglobinuria (iron-containing chromoprotein in urine).

Diseases that cause red urine, hematuria:

1. Urolithiasis, urolithiasis. According to statistics, 15-20% of all cases of the disease are accompanied by macrohematuria. The beginning of the process can also be manifested by such a sign as red urine, but erythrocytes are detected only in the laboratory. Migrating stones injure the tissue of the urinary system, bleeding is clearly visible in the urine, which acquires an unusual shade.
2. Adenocarcinoma (pelvic lesion), renal cell carcinoma (hypernephroma) – 90-95% of all tumor processes in the kidneys. Less common – nephroblastoma, clear cell sarcoma. Benign oncoprocesses – oncocytoma (oncocytoma), AML (angiomyolipoma), renal adenoma. Macrohematuria is manifested by blood clots in the urine, but in the initial stage the process is almost asymptomatic.
3. RMP ( bladder cancer ), ureteral cancer (usually as metastases of adenocarcinoma), urethral cancer.
4. GN (glomerulonephritis). Red urine in GN is considered a clinical manifestation of the progression of the pathological process.
5. Autoimmune systemic diseases of various types of connective tissue. In nephropathology, these are systemic vasculitis (Wegener's granulomatosis), angiitis, tubulointerstitial nephritis (interstitial), SLE (lupus erythematodes, systemic lupus erythematosus), reactive arthritis, gouty arthritis, Strumpell-Bechterew disease (ankylosing spondylitis, ankylosing spondylitis), RA (rheumatoid arthritis).
6. PPKD (polycystic kidney disease). Congenital pathology, often developing without clinical signs. Urine coloring in red shades indicates complications of an infectious nature, about the syndrome of insufficientia renalis: acute renal failure, insufficientia renalis acuta or chronic renal failure, chronic renal failure, insufficientia renalis chronica.
7. Drug-induced interstitial nephritis, which can be caused by more than 50 types of medications of different groups. The list is headed by antibiotics, NSAIDs (non-steroidal anti-inflammatory drugs), which provoke hematuria and can lead to ARF (acute renal failure) if taken without supervision. List of drugs:
   • Renal papillary necrosis may manifest itself as hematuria, leukocyturia, and pain symptoms (colic). Papillary necrosis is caused by a group of drugs: NSAIDs, analgesics, and Acidum acetylsalicylicum (aspirin).
   • Cystitis with blood (hemorrhagic). Provoked by cytostatics (Cyclophosphamidum, Mitotanum).
   • Kidney stone formation. Side effects of long-term treatment with ART (antiretroviral therapy) - Ritonavir, Triamterenum, Indinavirum, as well as anxiolytics - Remeron, Mirtazapinum.
   • There is a risk of developing a tumor process and the corresponding symptom - hematuria, with self-medication with phenacetin, with long-term use of cyclophosphamide.
8. Narrowing of the urethra (urethral stricture), duplication of the kidney, renovascular hypertension, nephroptosis. Trauma to the pelvis renalis membrane caused by intrapelvic pressure of urine, its poor outflow, lead to hematuria.
9. Infectious disease – pyelonephritis, pyelonephritis. Disruption of blood supply to the kidney, insufficient urine outflow provokes the appearance of blood in the urine.
10. Inflammatory process in the prostate, prostatitis – prostatitis. Hematuria in prostatitis is quite rare, but can also serve as a clear sign of exacerbation of the disease.
11. Tuberculosis of the kidneys (parenchymal tuberculosis, tuberculous papillitis). Accompanied by macrohematuria.
12. Venous hypertonia (hypertension).
13. Nutcracker syndrome, compression syndrome of the left renal vein, varicocele.
14. Focal necrotic kidney lesion, renal infarction.
15. Contusion, kidney injury.
16. Blood clotting disorder, coagulopathy.
17. Haemoglobinuria, hemoglobinuria due to intoxication, intravascular hemolysis, trauma, compressive nature (SDR - crush syndrome)

There are many different diseases that cause red urine to be released and they can be divided according to their severity:

Severe pathologies	Moderate illnesses	Diseases that respond well to therapy at an early stage of the process
Renal carcinoma RMP – cancer of the vesica urinaria (bladder) Nephrolithiasis with stones in the ureter Carcinoma of the prostate PPKD – polycystic kidney disease Tuberculosis (kidney tuberculosis) Hydronephrosis (hydronephrosis)	Nephrolithiasis (kidney stones) Infectious processes in the urinary system Bladder stones Interstitial cystitis	BPH, benign hyperplasia of the prostate gland

A wide range of various diseases that cause red urine require differential diagnostics. Diagnostic search, in turn, may require the involvement of doctors not only specializing in urology, but also endocrinologists, infectious disease specialists, and oncologists. Early diagnostics allows for faster therapeutic results and significantly reduces the risk of complications and negative prognoses.

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Red urine with cystitis

Inflammation of the mucous tissue of the bladder, cystitis, is rather one of the manifestations of the underlying disease that provokes the inflammatory process. This is especially characteristic of secondary cystitis in acute form. Red urine with cystitis is a clinical sign of infection penetration into the inner layers of the epithelium, when the tissue vessels are damaged and bleed. Depending on the course of inflammation, red urine with cystitis appears in the following forms of the disease:

• Hemorrhagic form of cystitis.
• Necrotic form, ulcerative cystitis.

1. Cystitis with blood, a hemorrhagic form of inflammation, is a process that affects the inner layers of the epithelium. This form is the most common and is caused by many pathological factors. Red urine may appear already in the first day from the onset of infection. The shade of urine quickly changes from light pink to red and even dark brown if the inflammation is not treated and transforms into an advanced stage. Infection is provoked by a wide range of bacteria, adenoviruses, Escherichia coli, Staphylococcus saprophyticus, Candida, Trichomonas and Herpesviridae.
2. The necrotic form is quite rare, since it is considered a complication after specific radiation treatment or a consequence of tuberculosis or syphilis.

Red urine during cystitis can be caused by the following diseases and conditions:

• Trauma or damage to the urethra during special urological procedures.
• Pyelonephritis.
• Prostate adenoma in men.
• Taking cytostatics and other medications that have side effects associated with the urinary system.
• STDs – the entire list of sexually transmitted diseases.
• Diabetes.
• Bladder stones.
• Glomerulonephritis.
• Chronic constipation.
• Oncologic process in the organs of the urinary system.
• Climax.
• Gross violation of the rules of personal intimate hygiene.

Hematuria caused by cystitis is characterized by the appearance of a red tint of urine at the end of the urination process. Less common are cases of urine coloration at the beginning and in the middle of the act, which may indicate a chronic course of inflammation.

Red urine after alcohol

The toxicity of ethanol deserves a separate, extensive and reasoned description. All drinks containing alcohol have a negative effect on the functions of the urinary system, especially on the filtration capacity of the kidneys. Red urine after alcohol is a visible sign that the parenchyma cells and other renal structures. Ethanol provokes excessive activity of the main points of the "obligatory" program of kidney work:

• Glomerular ultrafiltration of metabolic products.
• Reabsorptio - reabsorption.
• Selection, secretio.
• Metabolic function - gluconeogenesis.
• Cleansing, renal clearence.

Ethanol has a negative effect on the urinary system as a whole and can lead to the following conditions and pathologies:

• Acute or chronic inflammatory process in the vesica urinaria (urinary bladder), in the pelvis renalis (renal pelvis).
• Endocrine disorders, pathologies of the glandulae suprarenale (adrenal glands).
• Urolithiasis, nephrolithiasis (formation of kidney stones).
• Oncopathologies in the organs of the urinary system.
• General intoxication of the body.
• Chronic kidney pathologies, CKD (chronic kidney disease) - chronic kidney disease.
• ARF - acute renal failure.
• CRF – chronic renal failure.
• Pyelonephritis.
• Acute glomerulonephritis.
• Focal proliferative glomerulonephritis.

Red urine after alcohol is caused by an increased level of IgA in the blood (alcoholic hematuric nephritis). Which in turn can be explained by the compensatory mechanism of immunoglobulins against the background of total damage to the liver and pancreas. In clinical practice, it is customary to differentiate typical alcoholic glomerulonephritis from other pathologies. The main difference is the absence of pain during urination, microhematuria at the beginning of the process, a sharp increase in blood pressure. In addition, urine coloring in red shades is observed in APNP - alcoholic polyneuropathy, polymyopathy, when the heme-containing blood protein - myoglobin - enters the urine.

Toxic nephropathy is a very serious pathology that rarely stops at the ischemic stage. A favorable outcome depends on refusing to drink ethanol-containing liquids, timely treatment by doctors, and long-term, comprehensive treatment that prevents uremia and restores kidney function.

Red urine color in saturnism

Saturnism or chronic intoxication with the polytropic poison lead often proceeds without clinical manifestations until a critical level of carcinogens accumulates and the disease takes a severe form, affecting the human organs and systems totally. Red urine in saturnism is one of many symptoms indicating a violation of the enzymatic function, pathological processes in the cardiovascular, hematopoietic, urinary and nervous systems, dysfunction of the immune system and metabolism in general. WHO constantly publishes alarming statistics on the consequences of environmental pollution with lead compounds:

• Every year, the number of children diagnosed with mental retardation due to lead poisoning is confirmed. From 500 to 600 thousand children in all countries of the world are born with pathologies or suffer from acquired specific diseases associated with Plumbum.
• Every year, up to 140 thousand people die from lead poisoning worldwide, the overwhelming majority of these tragic statistics occur in Asian countries.
• Children under 5 years of age are most at risk of lead poisoning, as their bodies can absorb up to 40% of lead compounds. Compared to adults (5.5-10%), this figure looks alarming.
• The removal of lead by 75-80% is a function of the urinary system.
• Intoxication occurs when 1 to 3 milligrams of lead enter the human body. A life-threatening, lethal dose is 9-10 milligrams.

Target organs in lead poisoning:

• Skeletal system.
• Brain.
• CNS.
• Peripheral nervous system.
• Hematopoietic system.
• Kidneys.
• Liver.

Red urine in saturnism is observed already at the stage of kidney damage (nephropathy) and is combined with the following laboratory indicators:

• Proteinuria (increased protein levels in urine).
• Hyperuricemia (elevated uric acid levels).
• Cylindruria (the presence of blood cells and epithelial formed elements in the urine).
• Hematuria (red blood cells in urine).

Saturnism is easier to prevent than to conduct long courses of treatment. Prevention is the only way to reduce the risk of severe consequences of intoxication. Regular dispensary examinations should be carried out at lead-related industries. Children and adults living in areas with an unfavorable ecological environment, in industrial areas, need enhanced vitaminization, specific methods to reduce the threat of intoxication, and constant observation by the attending physician.

Red urine after catheter placement

Catheterization in urology has been used for quite a long time; the procedure began to be performed at the end of the 19th century. It is used for the following indications:

• Checking the patency of the ureter.
• Collection of clean urine without microflora for laboratory research.
• Exclusion or confirmation of leukocyturia.
• For pyelourethrography.
• Decompression procedure for neurogenic bladder syndrome.
• Monitoring the amount of urine at specified times of the day.
• Urodynamic studies.
• Urine collection from the right and left kidneys (separately) - for research.
• To clarify the sector of obstruction in the ureter.
• For the purpose of introducing medications directly into the vesica urinaria or urethra.
• Operations aimed at urine drainage.
• Antiseptic lavage of the bladder.
• To improve urine flow during inflammatory processes in the prostate.
• Restoration of urinary function (patency).

At the end of the procedure, many patients note that after the catheter is inserted, the urine is red. This is explained by the fact that catheterization, even if all the rules are followed, is a mechanical effect on the mucous tissues of the ureter. Consequently, microtrauma and the entry of red blood cells into the urine can be considered inevitable. A similar transient side effect is also caused by the insertion of a catheter into the vesica urinaria (bladder). The permissible period of hematuria after the manipulation is no more than 3 days. If after the catheter is inserted, the urine is red for longer than 2-3 days, post-manipulation complications may develop, which may be as follows:

• Perforation of the walls of the urethra. Strictura (narrowing) of the urethra.
• Blood loss causing a sharp drop in blood pressure.
• Cystitis.
• Purulent inflammation of the subcutaneous tissue (carbunculosis).
• Paraphimosis.
• Epididymitis.
• Infection of the urethra, urethritis, bacteriuria.
• Pyelonephritis.

Catheter-associated urinary tract infections accompanied by hematuria require additional therapeutic measures and complex antibacterial treatment.

Drugs that color urine red

The arsenal of pharmaceuticals used in the medicine of the 21st century includes more than 20 thousand medical preparations in various forms. About 40% of the adult population of the world takes medications daily. Each drug is capable of exerting a specific effect not only on the pathological target, but also on the results of laboratory tests, distorting their indicators initially. Chemical components of drugs are preserved in the blood, tissues and organs of a person for a certain period. These ingredients actively interact with special laboratory reagents, changing the final information of the tests. In laboratory practice, this process is called chemical interference. This is why it is important to take into account all the anamnestic details when making a diagnosis based on the examination, including remembering that there are drugs that color urine red without changing its other indicators.

List of medications that can color urine in shades of red:

• Anti-tuberculosis drug - Rifampicin.
• Antiseptics – Besalol, Phenyl salicylate, Salol.
• Acidum acetylsalicylicum - aspirin.
• Antimicrobial agents – Furagin, Furadonin, Urofuragin, Nitrofuran.
• Anti-inflammatory drugs – Alamidon, Pirafen, Novamidon, Pyrazon, Antipyrine.
• Laxative – Phenolphtaleinum, phenolphthalein.
• Uroantiseptic drug - Nitroxoline.
• Pain reliever - Analgin.
• Antibiotics from the group - carbapenems. Meropenem, Cilastatin, Propinem, Tienam.
• Nonsteroidal anti-inflammatory drugs - Ibuprofen, Brufen, Ibunorm, Nurosan.
• Preparations containing senna leaves, aloe, buckthorn, rhubarb root (anthraglycosides).
• Antiprotozoal drugs - Trichopolum, Gravagin, Metronidazole.
• Medicines containing riboflavin (vitamin B2) - Lactoflavin, Flavitol, Vitaplex B2, Ribovin, can color urine not only yellow, but also give it a red color.
• Antihypertensive drugs - Methyldopa, Dopanol, Aldomet.
• Antipsychotics - Chlorpromazine, Aminazine, Thiotidazine, Melleril, Tison.
• Cytostatics – Phosfamide, Cyclophosphamide, Azathioprine.

Drugs that color urine red are most often excreted through the urinary system, temporarily affecting urine parameters. In laboratory studies, it should be taken into account that the color, smell, and transparency of urine can be changed by medications and deviate from the normal range.

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Red urine when taking regulon

Oral contraceptives, like other drugs containing estrogen, steroids, are capable of changing biochemical processes in the liver, blood parameters. One of the most popular drugs in this category is Regulon, a hormonal combination drug aimed at suppressing FGS and LH (follicle-stimulating and luteinizing gonadotropins) to reduce and inhibit ovulation. The drug contains Aethinyloestradiolum (ethinyl estradiol) and Desogoestrelum (desogestrel).

With Regulon, red urine may be found in women who have increased sensitivity to the steroid components of drugs, as well as in those who have been diagnosed with hyperlipidemia, liver dysfunction. Regulon is capable

Change and disrupt the normal metabolic cycle of a specific pigment - porphyrin, a precursor of hemoglobin, and increase its excretion in the urine 9-14 days after starting to take the contraceptive.

A long course of treatment or incorrect dosage of OC (oral contraceptives) can cause the following side effects:

• Arterial hypertension (more than 140/90).
• Rarely - hemolytic uremic syndrome, a health-threatening and life-threatening condition characterized by ARF (acute renal failure), thrombocytopenia and anemia.
• Porphyrinemia and porphyrinuria.

Hematoporphyrinuria (the presence of pigments - porphyrins in the urine) as a secondary clinical symptom may be caused by the drug effect on the liver. With Regulon, red urine is a clear sign of a disorder of the pigment metabolism of the blood and an indication to stop taking the drug.

Milgamma turns urine red

Milgamma is prescribed as a neurotropic multivitamin for the treatment of the following diseases and conditions:

1. Fibromyalgia.
2. Paresis.
3. Neuralgia.
4. Radiculopathy.
5. Strengthening the immune system.
6. Polyneuropathies.
7. RBN – retrobulbar neuritis.
8. Recurrent viral infections (Herpesviridae group).
9. Stabilization of the hematopoiesis process.
10. Activation of blood microcirculation.

Milgamma colors urine red due to the presence of Cyanocobalaminum. Cyanocobalamin is metabolized and deposited in the liver, does not lose its activity during biotransformation and is eliminated with urine in a virtually unchanged form.

Vitamin B12 is irreplaceable as an anti-anemic, erythropotic agent. This vitamin was discovered and synthesized in the middle of the last century and since then has become a real salvation for patients with disorders of the nervous and cardiovascular systems. Cobalamin is especially useful for elderly people suffering from hearing loss, diabetes, polyneuropathy. Thus, milgamma colors urine red, but does not provoke true hematuria. The change in the shade of urine is a temporary phenomenon that disappears in 2-3 days.

Risk factors

Blood in the urine, urine of an atypical, reddish hue is a clinical sign of an abnormal condition of the urinary system in general and the composition of urine in particular.

Risk factors that can trigger the release of red urine:

1. Category of people suffering from chronic forms of various nephrological pathologies:
   • Patients with proteinuria.
   • Patients with clinical symptoms of renal failure.
   • Patients whose urine analysis shows an increase in the level of creatinine in the blood serum analysis.
2. People at risk for urological pathologies:

• Professional risks of intoxication - workers in the chemical industry.
• Bad habits, unhealthy lifestyle - smoking, drug and alcohol addiction.
• Age-related factors also influence risk factors. People over 45, especially men, fall into the risk category for developing urological pathologies.
• History of previous uropathology.
• A single or recurrent disorder of the urination process.
• Infectious diseases of the genitourinary system.
• STDs - sexually transmitted diseases in the anamnesis.
• Long-term treatment with analgesics.

3. Patients suffering from the following diseases:

• Hepatitis.
• Granulomatosis.
• Anemia of various types.
• Oncopathology.
• Cardiovascular diseases.
• Diseases associated with the hematopoietic system - leukemia, lymphoma.
• Congenital pathologies of the liver, kidneys, other organs and systems of the body.

Risk factors should be taken into account when prescribing medications, as well as in general in the differential diagnosis of the clinical manifestation of pathology in the form of hematuria - true or physiological.

Pathogenesis

There is still no single basic information that would accurately describe the pathogenesis of hematuria. Descriptions of the pathogenetic process of micro and macrohematuria are available in many textbooks and scientific papers. However, nephrologists and urologists around the world are continuously debating the classification of hematuria, an accurate research and statistically confirmed protocol that indicates the entire path of blood entering the urine. It is traditionally believed that erythrocytes penetrate into urine via the microcirculatory (capillary) bed. Thus, hematuria can be caused by dysfunction and damage to the glomerular capillares vasa. It is also known that the basement membrane is very vulnerable and erythrocytes can easily penetrate through it in a latent form - microhematuria, while macrohematuria, according to recent studies, is provoked by necrosis of the glomerular cells of the capillaries.

In general, the studied pathogenesis of hematuria describes the entry of blood into the urine as follows:

1. For various reasons (pathological or physiological), erythrocytes overcome natural barriers - the vascular wall, Capsula fibrosa renalis (fibrous capsule of the kidney), membranes in the renal glomeruli or the epithelial tissue of the mucous membrane of the bladder.
2. Hematuria can be renal or extrarenal:
   • Prerenal, extrarenal hematuria is caused by damage to the tissue of the kidney capsule, most often due to oncopathology. Also, prerenal entry of erythrocytes into the urine is associated with the presence of stones in the urinary system and their movement, excretion and disruption of the integrity of tissues along the path of elimination. Cystitis, cystomatosis, almost all STDs, tuberculosis can ulcerate the walls of the vesica urinaria (bladder) and cause extrarenal hematuria. Hemophilia, intoxication with anticoagulants are factors leading to disruption of the urinary system (URS) and the development of prerenal erythrocyturia. Thrombophlebitis caused by decompensation of the cardiovascular function activates intravascular pressure, gradually moving erythrocytes into the urine.
   • Renal, renal hematuria is almost always associated with a gross violation of the general structure of the kidneys. The membranes of the nephrons, which normally provide a long process of filtration and retention of red blood cells, are destroyed. Most often, this pathological condition is caused by bacterial inflammation, pyelonephritis or glomerular nephritis. Renal hematuria can be provoked by drug exposure, nephropolycystic disease, DIC syndrome, diseases of the hematopoietic system, hereditary pathologies
3. The information studied to date is subject to ongoing analytical discussion, a process that requires completion for accurate and timely diagnosis, differentiation of etiological factors and selection of a reasonable, effective course of treatment.

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Epidemiology

Statistics of cases of hematuria - true or false, these are epidemiological data on the underlying causes - pathologies of the urinary system that caused a change in the color of urine. The topic is very extensive and deserves a separate description, a brief epidemiological review looks like this:

• According to the World Health Organization, the annual growth of diseases related to nephrology and urology is growing by 3-5%. In the period from 2002 to 2009, the number of diagnosed nosologies in the category of urological diseases increased by 25.8%.
• In the structure of unfavorable prognoses and fatal outcomes, diseases of the genitourinary system are ranked 7th.
• According to data that is updated every year, nephropathology can be detected in 1.7-2% of the world's population.
• More than 60% of patients in urological clinics and hospitals are people under 40 years of age.
• The prevalence of the "invisible" presence of red blood cells in urine (microhematuria) is from 25 to 31%. Microhematuria can be detected in this number of people in 20% of cases randomly during a comprehensive examination and diagnosis.
• Microhematuria is common in 45% of men over 55-60 years of age.
• Microhematuria is found in 57-60% of smokers.
• Microhematuria is found in 14-15% of women over 50 years of age.
• The detection of blood in the urine, red urine requires further examination in 50% of people, of which 65-70% require further treatment of the detected etiological factor.
• More than 50% of urinary system pathologies in children occur without obvious clinical manifestations, asymptomatically.
• According to 2013 data, UTI (urinary system) diseases in Ukraine occupy 5th place in the structure of general morbidity.
• There is an alarming trend of increasing number of diagnosed MBC pathologies in adolescents. During the period from 2001 to 2015, this figure increased by 35-50% (exact data is distributed regionally by countries of the world). Girls predominate among patients (the figure is 5 times higher than that of adolescent boys).
• The list of the most dangerous nephro- and uropathologies includes chronic glomerulonephritis, urolithiasis and renal pathologies of infectious etiology.
• In 70-75% of patients with kidney tumors, asymptomatic macrohematuria is the only manifestation of the oncological process.
• In the presence of stones in the bladder, 80% of patients experience profuse hematuria as a clinical manifestation of urolithiasis.

The statistics provided are only part of a comprehensive review, but they also speak of the need for preventive measures and timely care for one’s own health.

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