User:Bron766/Haematuria/What is haematuria

 Goal: Make sure that when you use the term haematuria it is true haematuria and not a mimic. This is a quick tutorial about the definition of haematuria. This topic is important because there are several things that mimic haematuria, which can cause confusion.

[[Image:Nuvola apps kmessedwords.png|32px]] Explanation
What is haematuria?

Haematuria is blood (haemat) in the urine (uria).

How do I use the term?

To label a medical problem as true haematuria, it should meet two assumptions:
 * 1) It must be blood
 * 2) It must be coming from the urine / urinary tract.

Mimics of haematuria are caused by other substances making the urine appear red or dark brown (not red blood cells). Other things that can do this include foods (beets), medications (rifampicin) and myoglobin from muscle breakdown (rhabdomyolysis)... Also, even if it is blood, it may be coming from another orifice, e.g. from the rectum, or in females the vagina. People have also been known to falsely contaminate urine samples with blood from self-inflicted wounds to make it look like they have haematuria when seeking opioid painkillers for drug addictions.

The best ways to be sure it is blood include dipstick urinalysis and urine microscopy.

The best ways to be sure it is coming from the urine / urinary tract include asking about menstruation, examining for blood at the entrance to the urethra and examining the vagina and rectum for bleeding sites.

More terminology:
 * Macroscopic or Gross haematuria
 * Microscopic haematuria

[[Image:Picframe.svg|32px]] Examples
Cases:
 * A 75 year old man comes in to the Emergency Department and reports he is 'peeing blood'. He has a background of renal cell carcinoma. He is triaged appropriately as having gross haematuria.
 * An 80 year old female is brought to her GP by relatives who are concerned she is increasingly confused. Her urine sample looks yellow but is cloudy and malodorous. Urine dipstick analysis is positive for leukocytes, nitrites, blood and protein. She is diagnosed with a urinary tract infection and treated with antibiotics. Repeat testing a few weeks later shows persistent microscopic haematuria and she goes on to be investigated and diagnosed with bladder cancer.
 * A 16 year old female has a positive urine test for blood. On further information, she is currently having her normal menstrual period and has no other alarming signs or symptoms. The blood is coming from the vagina and mixing externally with the urine. The urine test was found to be incidental and unrelated to her presenting problem.
 * A 92 year old male is brought in after a fall several days ago. He has been lying on the floor at home, unable to get up, ever since. His urine is very brown, but tests positive for myoglobin not haemoglobin. He is diagnosed with rhabdomyolysis, a mimic of haematuria.
 * A 30 year old male presents asking for narcotics for his 'kidney stones'. He has normal vital signs and a normal examination when distracted. His urine sample has traces of blood in it, but the nurse notices a fresh puncture wound to his finger on returning from giving the urine sample. Further investigations show no evidence of stones. He spiked his urine sample with blood to gain narcotics and does not have true haematuria.