Erythrocytes in the urine: symptoms, effects, diagnosis

The clinical picture of the appearance of red blood cells in the urine is usually due to the underlying pathology.

The patient may voice complaints about the change in color of the urinary fluid - this is possible in the case of severe erythrocyturia. Color may vary:

• only at the beginning of the urinary process (with the defeat of the initial part of the urethra);
• only at the end of the urethra (with the defeat of the prostate gland, cervical bladder, internal urethral opening);
• in the entire volume of urine (in case of pathologies of the urea, ureters, pelvis, or kidney parenchyma).

Complaints of pain usually accompany urolithiasis, cystitis, uric acid crisis. In other cases, the pain may not be. At the same time, tumor processes in the bladder and kidneys are the most dangerous: in such cases, red blood cells are often found in the urine without symptoms, and pathologies are found only in a random (for example, routine) examination.

Symptoms such as fever and red blood cells in the urine are characteristic of many urinary infections. For accurate diagnosis, the doctor needs to evaluate the entire clinical picture as well as conduct additional diagnostic procedures.

With impaired kidney function, the body poorly removes water and salt, which provokes the appearance of edema. Swelling occurs in the morning - in the form of swollen eyelids and bags under the eyes; by evening, this symptom usually disappears. Red blood cells in the urine and edema with the morning periodicity - this is a sure sign of kidney problems. Heart disease is characterized by "lower" and "evening" puffiness, when fluid accumulates closer to the second half of the day in the lower extremities (mainly in the ankles and feet).

What does a red blood cell look like in the urine?

Red blood cells in the urinary fluid with an isotonic reaction look like yellowish or red discs concave from two planes. If the environment is hypotonic or alkaline, then the red blood cells can grow in size and be almost colorless - in medicine such structures are called “red blood cell shadows”. Under the conditions of an acidic environment or a concentrated uric fluid, they acquire uneven boundaries and become wrinkled. Normal and altered erythrocytes in the urine are well visualized when using the phase-contrast microscopic method.

As we have said, an indicator of the norm is considered when there are no red blood cells in the urine, or their number is 1-2 or three in the field of view. In any case, such a string as a result of analysis, such as “red blood cells in the urine of 1, 2, 3, 5, 10 and more,” should alert. It is possible that the doctor will advise to be re-examined.

Red blood cells in urine sediment are:

• Modified, or leached red blood cells in the urine - without hemoglobin, discolored, single or double-contoured, of reduced size (compared with a normal red blood cell). Such structures are often found in the urinary fluid at low relative density, in an acidic environment (at pH 5-6), or during their prolonged stay in urine.
• Unchanged red blood cells in the urine - with hemoglobin, having a discoid shape (possible form of a lens, concave with two planes). Such structures are characteristic of a weakly acidic, neutral or alkaline environment.

In terms of morphology, red blood cells may differ, depending on which part of the urinary tract they came from. For example, in renal pathologies, these cells are dysmorphic (against the background of a large number of erythrocytes, they can be both dysmorphic and unchanged).

Unchanged, or so-called fresh red blood cells in the urine indicate damage to the urinary tract - for example, the bladder or urethra.

Dysmorphic erythrocytes in the urine appear in the case of impaired filtration process in the renal filter (with excessive permeability). A large level of dysmorphic cells indicates mainly the renal etiology of the disease.

However, the main symptom of kidney problems is considered such that protein, red blood cells and cylinders are present in the urine at the same time.

Flat red blood cells in the urine may indicate a pathology of the urinary system, for example, accompanied by iron deficiency anemia or other types of anemia.

Leukocytes and erythrocytes in the urine are found on the background of infectious diseases, as well as pyelonephritis, prostate or bladder tumors, diseases of the connective tissue, and even with exacerbation of pancreatitis or during fever. Since the causes of the problem can be many, it is recommended to retake the urine test, and also conduct an additional study on Nechyporenko.

Protein and red blood cells in the urine can appear temporarily - this happens when intense physical overload, severe stress or hypothermia, an allergic process. During pregnancy, this combination of unfavorable indicators is observed due to mechanical pressure on the kidneys (as a rule, this can be determined in the later periods). But such a violation is found in other serious diseases, so without a qualitative diagnosis is not enough.

Red blood cells and hemoglobin in the urine are found most often when blood enters the urinary tract - for example, against the background of glomerulonephritis, inflammatory diseases, tumors. Hemoglobin without red blood cells in the urine is detected as a result of the destruction of the latter inside the vessels. This is typical for hemolytic anemia and possibly for intoxication, diseases of the spleen, allergies, infectious processes, injuries. These diseases are characterized by an increased level of hemoglobin in the blood plasma: due to an excess of protein, it overcomes the glomerular filtration and enters the urinary fluid. This condition is considered quite dangerous and may be complicated by renal impairment.

Both red blood cells and hemoglobin can be detected in the urine of athletes: this is a temporary phenomenon and is not considered a pathology.

Bacteria, leukocytes, erythrocytes in the urine indicate a probable infectious lesion of the urinary organs. But it should be borne in mind that often bacteria enter the urinary fluid during an incorrect sampling. Therefore, it is recommended to always pass urine again.

Presence in the analysis of salts in large quantities also helps to make a preliminary diagnosis. If a little salt is found, then it is not considered a pathology and may speak about some peculiarities of the patient’s nutrition.

Urate salts and erythrocytes in the urine against the background of an acidic reaction indicate the possible presence of urate stones, an excess of animal protein in the diet, and strong intoxication in the body.

Oxalates and red blood cells in the urine are found in those people who eat many foods with a high content of oxalic acid. This is also possible with the formation of oxalate stones, diabetes, chronic intestinal pathologies, pyelonephritis.

Phosphates and erythrocytes in the urine against the background of an alkaline reaction indicate the presence of phosphate stones in the urinary system, which are formed when the phosphate metabolism is disturbed in the body (sometimes found in followers of vegan nutrition).

The renal epithelium in the urinary fluid is usually not detected in healthy patients. Epithelium and red blood cells in the urine may be present in inflammatory diseases affecting the renal tubules, as well as in glomerulonephritis.

Another possible component detected in the composition of urine is bilirubin. This is a bile pigment, which is formed with the destruction of red blood cells and the breakdown of hemoglobin. This component is usually present in the analysis in meager amounts that are impossible to determine. Erythrocytes and bilirubin in the urine in large quantities can be detected during tumor processes, with liver cirrhosis and hepatitis.

It is important to correctly correlate the results of two general tests - blood and urinary fluid. For example, erythrocyturia often occurs simultaneously with signs of an inflammatory process or anemia. And eosinophilia and erythrocytes in the urine may indicate the presence of non-atopic dermatological diseases, rheumatism, allergic processes. However, in some cases, this combination occurs after prolonged use of acetylsalicylic acid or some injectable antibiotics.

Many erythrocytes in the urine are marked against the background of infectious, traumatic, autoimmune, toxic, tumor and mixed factors. A strong increase in performance as a result of the analysis can seriously frighten the patient: erythrocytes in the urine often indicate the development of bleeding in the urogenital system, which may be related to injuries and neoplastic processes. It is possible to make the correct diagnosis even after a thorough questioning of the patient, collecting complaints, clarifying the nature of the pathology.

Single red blood cells in the urine — namely, 1, 2, or 3 — are considered a standard variant and do not require any medical intervention. The same can be said if traces of red blood cells are found in the urine: in some cases, at the discretion of the physician, a second test can be recommended.

Diagnostics of the red blood cells in the urine

If a patient has red blood cells in the urine, the doctor should conduct a series of additional examinations. First of all, a survey and examination of the patient is carried out, the abdominal cavity is palpated. For men, it is important to do a rectal examination to detect an increase or inflammation of the prostate. For women relevant gynecological examination.

In addition, the patient is examined in terms of enlarged lymph nodes, hemorrhages, petechiae, etc.

The determination of erythrocytes in the urine is carried out by a microscopic method, during the general analysis - one of the most common diagnostic studies. Such an analysis can be prescribed for most diseases. It includes the definition of up to two dozen indicators - including the presence and number of red blood cells.

Urine tests are carried out on a mandatory basis: the presence of protein, the erythrocyte morphology, the presence of leukocytes and cylinders are examined.

Microscopic examination of urine sediment helps to detect:

• the presence of unchanged erythrocytes;
• the presence of modified erythrocytes (characteristic of glomerulonephritis) and erythrocyte cylinders.

Additionally, urinary fluid is cultured (if an infectious process in the urinary tract is suspected). If urinary tract tuberculosis is suspected, such seeding is repeated three times.

Cytology of urine sediment is indicated if there is reason to suspect a tumor in the lower urinary segment. For malignant processes in the kidneys, this procedure is not informative.

Standardly designate a general blood test with the calculation of ESR, the determination of blood urea nitrogen, as well as creatinine in blood serum. If glomerulonephritis is suspected, it is advisable to evaluate the titer antistreptolysin O, with the level of complement components in the plasma.

Instrumental diagnostics, first of all, are represented by the methods of excretory urography and ultrasound examination of the right and left kidney (the lower urinary tract is not examined by ultrasound due to its low informativeness).

The following may be recommended as auxiliary procedures:

• CT scan;
• renal angiography;
• ascending pyelography;
• urethroscopy, cystoscopy;
• renal tissue biopsy (especially indicated for the detection of altered red blood cells in the urine).

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

Differential diagnosis

Differential diagnosis of the appearance of red blood cells in the urine is carried out with the following diseases:

• urinary tract infections (cystitis or urethrotrigonitis in female patients, urethritis or prostatitis in male patients);
• urolithiasis (formation of stones in the kidneys, bladder, ureters);
• vascular pathologies (renal vein thrombosis, kidney infarction);
• tumor processes (oncology of the kidney, renal pelvis, ureter, bladder, prostate);
• infectious processes (tuberculosis, malaria, endocarditis);
• glomerulonephritis;
• damage to the dilated vessels on the background of prostate adenoma;
• necrotic processes in the renal papilla.

You should also consider the likelihood of blood pathologies in which the appearance of bleeding is possible, as well as hematuria during physical overload.

More rare pathologies, which also need to be differentiated, are renal polycystic, urinary endometriosis, schistosomiasis, hemorrhagic and systemic vasculitis.

[7], [8], [9], [10], [11], [12], [13]

Complications and consequences

The likelihood of adverse effects and complications on the background of the appearance of red blood cells in the urine depends not on the specific fact of their detection, but on the initial cause of the violation. Thus, complications can develop in the absence of treatment for pyelonephritis, urolithiasis, and so on. In itself, erythrocyturia is only a symptom, not a diagnosis, therefore it is at least inappropriate to determine the consequence of a symptom.

In any case, the presence of red blood cells in the urine requires further examination to identify causal pathologies. And only on the basis of the established final diagnosis can predictions about possible complications be made.

[14], [15], [16], [17]

Prevention

It is impossible to determine the specific prevention of the appearance of erythrocytes in the urine, since the development of the violation occurs for many reasons.

In order to avoid problems, you should follow these recommendations:

• avoid hypothermia, especially the lower back, abdomen and groin area;
• establish for themselves the right diet to prevent the formation of urolithiasis, intoxication;
• drink plenty of fluids daily;
• avoid excessive physical exertion;
• prevent trauma to the organs located in the abdominal cavity.

Periodically, you should visit the doctors for a routine checkup.

[18], [19]

Forecast

When red blood cells are detected in the urine, it is immediately difficult to determine the severity of the violation: the nature of the consequences depends on the severity of the disease that caused it.

In most cases, isolated erythrocyturia has a favorable prognosis. Adverse are the cases when erythrocytes in urine are present on the background of proteinuria or nephrotic syndrome, systemic lupus erythematosus, Alport syndrome, extracapillary or tubulointerstitial nephritis, renal polycystic disease, tuberculosis, neoplastic processes, IgA-nephropathy with a nephrotic syndrome, and an IgA-nephropathy with a nephrotic syndrome and an obstructive syndrome.

[20], [21], [22]