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1、Diagnosis of hematuria,The concept of hematuria,microscopic hematuria : RBC Under the microscope ：3/HP(not centrifugal) 5/HP(centrifugal) or 12h urine Addis account500,000 macroscopic hematuria : Urine appearance look like faint red 、red 、dark red or tea brown and others,hematuria,Physiological hema
2、turia Pathological hematuria,Physiological hematuria,fever cold strenuous exercise（exertional hematuria） Others: come from menstrual blood（before or after menstrual period，intermenstrual flow）、hemorrhoids etc,Pathological hematuria,the urinary system disease Systemic disease others,the urinary syste
3、m disease,urinary stone Infection of the urinary (adjacent organs) primary nephritis secondary nephritis acute renal failure, ARF,interstitial nephritis tumour of the urinary (adjacent organs) renal vascular disease others renal disease,primary nephritis,primary glomerulonephritis（acute or chronic）
4、nephrotic syndrome IgA nephropathy latent glomerulonephritis rapidly progressive glomerulonephritis,RPGN,secondary nephritis,diabetic nephropathy lupus nephritis anaphylactoid purura nephritis APN Hepatitis B virus associated glomerulonephritis gouty nephropathy hypertensive renal disease etc,renal
5、vascular disease,the left renal vein entrapment syndrome (nutcracker phenomenon) thrombus arteriovenous fistula renal angiomyolipoma etc,others renal disease,Nephroptosis floating kidney（wandering kidney） renal cyst polycystic kidney Alport syndrome familial recurrent hematuria syndrome Goodpastures
6、 syndrome etc,Systemic disease,hemorrhagic disease heart failure connective tissue disease infection endocrine disease multiple myeloma ,MM amyloidosis,AL,connective tissue disease,systemic lupus erythematosus ,SLE dermatomyositis ,DM vasculitis polyarteritis nodosa scleroderma rheumatoid arthritis
7、arthritis pauperum anti-phospholipid syndrome, APS sarcoidosis,infection,leptospirosis haemorrhagic fever with renal syndrome filariasis typhoid hematosepsis bacterial endocarditis Legionnaires disease scarlet fever Leprosy Syphilis malaria,Endocrine disease,gout diabetes hyperparathyroidism,others,
8、Injury urinary tract deformity radiation nephropathy Contrast nephropathy Sickle-cell disease certain medicines ：Gentamicin，Kanamycin，Tobramycin，Clindamycin，Cefradine，ribavirin ，Acyclovir，sulfa drug，anti-coagulants, Aspirin，chloramphenicol，lead、Hg、arsenic，mannitol、glycerol，tetracycline，CTX,etc,Judge
9、 the source of hematuria,hematuria 3-cups test Method： After cleaning the vulva and urethral meatus，collect the first 10-20ml urine into the first cup；the middle 30-40ml urine into the second cup ；the last 5-10ml urine into the third cup.,Result :,+ - - ：urethritis - - +：Cystitis，trigonumvesicae，pro
10、statitis，posterior urethra +： bladder or above the bladder,Distinguish renal and postrenal,glomerular basement membrane GBM,Renal hematuria,RBC morphology in urine ： the abnormal RBC in the urine is more than 80% under the microscope or the spores of RBC is more than 2% under the phase contrast micr
11、oscope,RBC under the microscope,examination,Urine analysis RBC morphology in urine Abdominal X-ray urinary system U/S urinary system CT scan urinary system MRI Angiography TB cystoscopy,CBC blooding time, coagulation time BS ESR,CRP Hepatitis Series and virus PCR Bone marrow aspiration renal biopsy
12、Special antibody test (ANA,ANCA,anti-ds-DNA,ACA, anti-GBM, EHF-IgM ),And enquire in detail,Medical history drug history infectious disease allergic history family history injury history,principle of treatment,Control target: RBC : less than 10/HP,Renal hematuria,steroid and immunosuppressant Prevent
13、 to use the drug which would damage renal function or cause hematuira If gross hematuria is obvious, we could use the hemostatic （adrenosem，etamsylate ， Hemocoagulase） If the disease is severe, beginning blood purification early as needed.,Postrenal hematuria,Stop the drug maybe cause hematuria Cure the Primary Disease anti-infection Hemostasis：Hemostatic , continuous bladder irrigation ，cystoscopy interventional therapy operation,Thank you !,