요약
Gross haematuria is urine that is visibly discoloured by blood or by blood clot. It may present as urine that is red to brown, or as frank blood. As little as 1 mL of blood can induce colour change in 1 litre of urine. By contrast, microscopic haematuria is not visible to inspection and is defined as three or more RBCs/HPFs on microscopic inspection.
The prevalence of gross haematuria is 2.5%, making it a relatively common diagnostic dilemma for primary care and emergency department physicians. [1] Gross haematuria, even when transient or asymptomatic, may indicate a significant disease process and always requires further investigation. In a prospective study of 1930 patients with microscopic and macroscopic haematuria, 21% of patients with gross haematuria harboured urological malignancy. [2] Cancer was found 4 times more often in cases of gross haematuria than in patients with microscopic haematuria. [2] Gross haematuria is a presenting sign in more than 66% of patients with urological cancer. [3] The sensitivity of gross haematuria in revealing malignancy is significant: 0.83 for transitional cell carcinoma of the bladder, 0.66 for ureteric carcinoma, and 0.48 in renal cell carcinomas. [4]
Gender differences exist in the oncological significance of gross haematuria. In men aged over 60 years, the positive predictive value of gross haematuria for urological malignancy is 22.1%, and in women of the same age it is 8.3%. [5]
감별 진단
- Common
- Uncommon
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- Renal trauma
- Bladder trauma
- Urethral trauma
- Sickle cell anaemia
- Coagulopathy
- Cystic renal disease
- Arterial-venous malformation
- Renal vein thrombosis
- Extrapulmonary tuberculosis
- Benign familial haematuria (thin basement membrane nephropathy)
- Post-infectious glomerulonephritis
- Membranoproliferative glomerulonephritis
- Rapidly progressive glomerulonephritis
- IgA nephropathy
- Systemic lupus erythematosus
- Renal cancer
- Metastatic cancer
- Urethral cancer
- Penile cancer
- Placenta percreta
- Endometriosis
- Bladder stone
- Radiation cystitis
- Cytotoxic medications
- Anticoagulation
- Exercise-induced haematuria
- Loin pain haematuria syndrome
- Medication
- Food-related
