Macrohematuria in men and women what is it, symptoms and treatment

Normally, urine has a light yellow or straw tint, but in the presence of some diseases, its color may change. Urine staining in a red tint indicates the presence of erythrocytes (red blood cells) in it in the range higher than that provided by the norm. This condition is called hematuria.

With a slight increase in the content of erythrocytes in the urine, they speak of microhematuria. If the color of urine is rich brown, almost black, blood clots are visible in it, we are talking about gross hematuria.

Gross hematuria is rarely an independent disease, more often it is a symptom of serious inflammation.


In women, gross hematuria usually indicates cystitis (inflammation of the urinary reservoir), urethritis. In men, more often – for pyelonephritis (bacteriological disease of the kidneys, renal pelvis), tumors of the urinary system, renal trauma, hemophilia, less often – cystitis.

In women during pregnancy, gross hematuria almost always indicates the threat of its termination, and can also be the result of ruptured tubes during an ectopic pregnancy, infectious inflammation of the genitourinary system.

In general, nonrenal and renal forms are distinguished. The first develops as a result of injuries to the walls of the urinary system, as well as with tumors, stones and sand in the urinary reservoir, ureter.

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The reasons for the development of renal gross hematuria can be as follows:

  • Kidney infections.
  • Inconsistency between the patient’s Rh factor blood and the donor’s blood during transfusion.
  • Pyelonephritis.
  • Renal tissue necrosis.
  • Stones in the kidneys.
  • Acute intoxication.
  • Thrombosis, kidney embolism.

Macrohematuria can be of the following subspecies:

  • Initial. It is characterized by the release of blood at the first portion of urine, which is usually associated with tumors of the urethra, injuries of the bladder and urinary system. Also, the occurrence of this form of macrohematuria can be caused by trauma to the urethra during medical procedures.
  • Terminal. In this case, an excess of the norm of erythrocytes is diagnosed in the last portion of urine, which indicates bleeding in the bladder. The latter can be caused by ulcers, tumors, stones in the organ.
  • Total. With this form of macrohematuria, the entire portion of excreted urine contains blood impurities. The reason is inflammatory processes in the kidneys (necropapallitis, pyelonephritis). The most dangerous of all types of gross hematuria, because in the absence of proper timely treatment, it provokes irreversible changes in the work of the upper urinary tract.

    Depending on the etiology, gross hematuria is classified as:

    • Glomerular. Blood enters the urine through the renal glomeruli. Usually, this gross hematuria is total in nature, accompanied by proteinuria (the presence of protein in the urine within the range above normal)
    • Non-glomerular. The bleeding source is located near the glomerular filter.

    If the developmental mechanisms are based on the classification, then the following types of macrohematuria are distinguished:

  • Extrarenal type, which is not characterized by kidney damage,
  • Idiopathic, that is, arising for the first time. It is most often found during pregnancy due to hormonal changes in the body or mechanical damage to the kidneys under the influence of the pressure exerted by the fetus.
  • Renal, caused by renal disease,
  • Postrenal, the source of bleeding in which is the bladder.

    Finally, based on clinical manifestations, gross hematuria is:

    • Painful or no painful symptoms.
    • Isolated (no other symptoms)
    • Combined with proteinuria.
    • Recurrent.
    • Persistent (characterized by duration, up to several years)
    • Essential (a rare form of macrohematuria, in which it is not possible to reliably establish the cause of its appearance).

    clinical picture

    Depending on the etiology and stage of development, macrohematuria may be asymptomatic or be accompanied by the following symptoms:

    • Painful urination – burning, sharp pain, thin urine stream, intermittent,
    • Temperature rise to 38-39C.
    • Frequent urge to urinate, mostly false.
    • A feeling of incomplete emptying of the bladder after urination.
    • Aching pain in the lumbar, pubic areas.
    • Pallor of the skin, itching.
    • Weakness.
    • Thirst, dry mouth.

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    With all types of gross hematuria, an uncharacteristic color of urine, the presence of blood clots in it, which are noticeable even with the naked eye, will become a clear symptom.

    Methods of diagnosis

    Diagnostic measures begin with the collection and analysis of anamnesis, visual examination of the patient. A blood test is prescribed, as well as a general urine analysis, urine diagnostics according to Nechiporenko and the three-glass method.

    To identify the condition of the kidneys and urinary system, ultrasound is performed, to determine the condition of the urinary reservoir – endoscopic examination (cystoscopy).

    To identify kidney function, excretory urography is performed, which is an X-ray study using contrasting compounds that are injected through the patient’s veins. When a tumor is detected, a biopsy is performed to clarify its nature.

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    All therapeutic measures should be carried out only after establishing the cause of gross hematuria. As an emergency universal remedy, it is permissible to prescribe pain relievers, as well as the imposition of cold compresses, ice packs on the lower abdomen to stop bleeding and prevent the development of anemia.

    Depending on the etiology and stage of gross hematuria, the following treatment methods are possible:

    • Emergency or elective surgery (if bleeding is caused by tumors, structural changes in the kidneys, or other treatments are ineffective)
    • Prescription of drugs that promote blood coagulation and stop bleeding (“Aminocaproic acid”, “Fibrinogen”, “Vikasol”)
    • Taking antibiotics of a broad spectrum of action to relieve inflammatory processes.
    • Installation of a catheter in the bladder through which a solution of caproic acid flows.
    • Administration of antispasmodics (in the presence of stones in the bladder)
    • Appointment of vitamin complexes (as a rule, iron-containing agents and B vitamins).

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    With gross hematuria, bed rest and diet are shown. The latter does not allow the use of spicy, fatty, salty foods, alcohol.

    Complications and consequences

    With prolonged macrohematuria, anemia almost always develops, characterized by low hemoglobin. There is a high probability of blockage of the ureter with a blood clot, due to which the patient is unable to urinate, the general condition of the body worsens.

    If the cause of gross hematuria is renal pathology, then intoxication of the body occurs, the patient may complain of weakness, dizziness, nausea, his temperature rises. With acute pain symptoms, pain shock may develop.

    The presence of blood in the urine is a clear symptom of a malfunction in the body, so patients usually seek medical help in the early stages. The disease has a favorable prognosis. With prolonged neglect of gross hematuria, disability and death of the patient are possible.

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    Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.