Difference between microscopic hematuria and gross hematuria

The article was professionally consulted with MSc Vo Thien Ngon - Urologist, Department of General Surgery, Vinmec Da Nang International Hospital.

Hematuria is a medical condition that occurs due to many different causes. Hematuria, whether gross or microscopic, needs to be diagnosed with the cause and treated promptly. So what is the difference between gross hematuria and microscopic hematuria?

Blood in the urine, also known as hematuria. This is blood in the urine. Hematuria is classified into two types: microscopic hematuria and organic hematuria.
In which, gross hematuria is usually visible hematuria. As for microscopic hematuria, hematuria is invisible to the naked eye. The disease is detected only when a urine cytology test results in a red blood cell count > 10000 erythrocytes/ml.

There are many causes of hematuria. Most causes of gross hematuria are also causes of microscopic hematuria.
These causes include: Due to causes in the kidney, outside the kidney and other causes, specifically as follows:
Causes in the kidney such as: kidney stones, glomerulonephritis, pyelonephritis, interstitial nephritis, kidney injury, kidney malformation, kidney tumor, kidney cyst, kidney tuberculosis, upper urinary tract infection...

Non-renal causes such as: bladder stones, prostate enlargement, prostate cancer, cystitis, bladder tumors, bladder rupture, urethral stones, urinary tract malformations, urethral polyps, Lower urinary tract infections... Other causes such as: Excessive exercise, drugs such as anticoagulants, non-steroidal anti-inflammatory drugs, urinary catheters, interventional procedures in the urinary tract.. In addition, the phenomenon of red urine not due to hematuria is also due to a number of reasons such as: Due to certain foods, some drugs rifampicin, metronidazol ... blood in the urine in menstruating women, hemolysis in the vascular bed. In order to accurately diagnose gross hematuria or microscopic hematuria, it is necessary to be re-checked with laboratory tests.

3.1 Observation with the naked eye Gross hematuria is a condition in which blood in the urine can be observed with the naked eye, detected when observing the urine with a dark red color. Also, microscopic hematuria cannot be observed with the naked eye, but is detected through tests such as urinalysis or urinalysis.
3.2 Reflects the level of blood in the urine Macroscopic hematuria is the amount of blood There is enough urine in the urine to be seen with the naked eye. Microscopic hematuria: It is not noticeable to the naked eye, only detected when doing urine cytology with a red blood cell count > 10,000 red blood cells/ml.
3.4 Symptoms of gross hematuria may be accompanied by other symptoms such as: Painful urination, frequent urination, pain in the hips and back, pain in the lower abdomen, etc. eyes dizziness, fatigue, rapid pulse, low blood pressure,...
As for microscopic hematuria, there may be no special clinical manifestations, which can be detected incidentally through testing.
3.5 Definite diagnosis Microscopic hematuria: Microscopic examination found many red blood cells. To be accurate, it is necessary to make an Addis residue to count red blood cells. In women, it is necessary to have a urinary catheter to take a urine test, to avoid mixing blood due to menstruation. Gross hematuria: Red, cloudy urine, sometimes with blood clots. For a long time, there are red blood cells.

It is necessary to coordinate with other laboratory tests to diagnose the cause of hematuria. Treatment of hematuria if the cause has not been found is mainly symptomatic treatment. Including:
Hemostatic drugs: Transamin orally or intravenously Blood transfusion in case of blood loss. Antibiotics if there are signs of infection such as Sulfamide group, Quinolone, can be combined with other groups depending on clinical progress. Blood and urine cultures and results according to the doctor's orders. In some cases, if there is a lot of obstruction of the urinary tract due to blood clots, it is necessary to temporarily have surgical intervention to drain and collect blood clots in the bladder such as: catheterization, urethral dilation if there is obstruction before resolve the cause. Treatment of the cause: surgical intervention depends on the cause of hematuria and the specific clinical condition of the patient.