#hematuria

[mcatmemoranda]

From the 2021 and 2022 ABFM in training exams.

[yes-06]

Hematuria.

[drforambhuta]

Urinary tract infections (UTIs) encompass a range of bacterial infections that impact various segments of the urinary tract, including the kidneys, bladder, ureters, and urethra. Although prevalent across all age demographics, UTIs present distinct challenges in pediatric patients due to their unique anatomical and physiological characteristics.

Causes:

UTIs in children commonly arise from microbial colonization of the urinary tract by pathogenic bacteria, notably Escherichia coli (E. coli). Several factors contribute to pediatric UTIs, including:

1. Structural anomalies: Anomalies like vesicoureteral reflux (VUR), urethral strictures, or congenital malformations predispose children to UTIs.

2. Hygiene practices: Poor personal hygiene, especially inadequate wiping after bowel movements or incomplete genital cleaning, can facilitate bacterial entry into the urinary tract.

3. Voiding dysfunction: Dysfunctional voiding patterns, like holding urine for extended periods or incomplete bladder emptying, create favorable conditions for bacterial proliferation.

4. Immunocompromised status: Children with compromised immune systems due to medical conditions or immunosuppressive therapies are at increased risk of UTIs.

5. Genetic factors: Certain genetic traits may increase susceptibility to recurrent UTIs in children, though more research is needed to understand the mechanisms fully.

Symptoms:

Early recognition of UTI symptoms in children is vital for prompt diagnosis and treatment. Symptoms include:

1. Dysuria: Pain or discomfort during urination, often leading to crying or fussiness.

2. Frequency and urgency: Increased urination frequency or sudden urges to urinate, disrupting daily routines.

3. Hematuria: Presence of blood in urine, either visible or microscopic, indicating urinary tract inflammation or injury.

4. Abdominal discomfort: Lower abdominal pain or pelvic pressure, particularly in older children capable of expressing their symptoms verbally.

5. Systemic symptoms: Fever accompanied by chills, lethargy, irritability, or decreased appetite suggests systemic involvement.

There are many good hospitals in India that offer health checkup packages for children. Regular full body health checkup can help in detecting UTIs early, identifying its possible cause, and providing an effective treatment plan for the same.

[myhealthhospital]

Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

Haematuria: Causes, Symptoms, and Treatment

Haematuria, or blood in urine, can be alarming but is often not a cause for major concern. However, it can sometimes indicate a serious underlying condition. Here's what you need to know about haematuria, its causes, symptoms, and treatment options.

Causes: Haematuria can be caused by various factors, including urinary tract infections (UTIs), kidney infections, kidney stones, strenuous exercise, and certain medications. In some cases, it may also be a sign of more serious conditions such as kidney disease, bladder cancer, or prostate problems.

Symptoms: The primary symptom of haematuria is pink, red, or cola-colored urine, which can vary from visible blood to microscopic amounts. Other symptoms may include pain or burning sensation during urination, frequent urination, and abdominal pain.

Treatment: The treatment for haematuria depends on the underlying cause. For minor cases, such as those caused by UTIs, antibiotics may be prescribed. In cases where kidney stones are the cause, medications or procedures to remove the stones may be necessary. For more serious conditions like bladder cancer, treatment may include surgery, chemotherapy, or radiation therapy.

Haematuria should not be ignored, especially if it is persistent or accompanied by other symptoms. If you experience blood in your urine or any associated symptoms, it is important to consult a healthcare provider for proper diagnosis and treatment.

[urosaketnarnoli]

In this comprehensive guide, a prominent urologist delves into hematuria, shedding light on its diverse causes, ranging from benign to serious, while offering valuable insights into diagnosis, treatment, and the importance of timely medical consultation for this concerning urinary symptom.

[urologist-surgeon]

Blood in the urine, also known as hematuria, is a clinical symptom that is characterized by the presence of red blood cells (RBCs) in the urine. This condition may manifest as gross hematuria, which is visible to the naked eye, or microscopic hematuria, which requires microscopic analysis of the urine to identify RBCs. Blood in the urine is an important indicator of underlying diseases of the urinary tract and can result from a wide range of causes, such as urinary tract infections, kidney stones, bladder cancer, and other systemic disorders.

[drguptasclinic1]

All You Need to Know About Vaginal Discharge Treatment

Vaginal discharge is a common issue that women face at some point in their lives. It is a fluid that is secreted from the vagina and helps to keep it clean and healthy. However, when there is an excessive amount of discharge, it can indicate an underlying condition that requires treatment. In this blog post, we will discuss the causes, symptoms, and treatment options available for vaginal discharge.

Causes of Vaginal Discharge:

There are many factors that can cause vaginal discharge, including:

Bacterial vaginosis: This is a bacterial infection that causes an increase in vaginal discharge and a foul odor.

Yeast infection: A yeast infection is caused by an overgrowth of yeast in the vagina, leading to discharge that is thick and white.

Trichomoniasis: This is a sexually transmitted infection that causes a yellow or green discharge with a foul odor.

Menopause: As women age, their hormone levels change, leading to a decrease in vaginal lubrication and an increase in vaginal dryness and discharge.

Symptoms of Vaginal Discharge:

The symptoms of vaginal discharge vary depending on the underlying cause. Some of the most common symptoms include:

A foul-smelling discharge

Itching and irritation around the vagina

Pain during sexual intercourse

Pain or burning sensation during urination

Redness and swelling around the vagina

Treatment for Vaginal Discharge:

The treatment for vaginal discharge depends on the underlying cause. Some of the most common treatment options include:

Antibiotics: Antibiotics are often prescribed to treat bacterial vaginosis and other bacterial infections.

Antifungal medications: Antifungal medications are used to treat yeast infections.

Antiprotozoal medications: Antiprotozoal medications are used to treat trichomoniasis.

Hormone therapy: Hormone therapy can be used to treat menopause-related vaginal dryness and discharge.

Lifestyle changes: Making lifestyle changes such as wearing cotton underwear, avoiding douching, and practicing safe sex can help reduce the risk of vaginal discharge.

In conclusion, vaginal discharge is a common issue that can be caused by many factors. It is important to seek medical attention if you are experiencing an excessive amount of discharge or any other symptoms. By understanding the causes, symptoms, and treatment options available, you can take control of your vaginal health and live a happy, healthy life.

[jcrmhscasereports]

Acute kidney injury following exposure to a formaldehyde –free hair straightening products by Dr. Nabil Abu-Amer in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

Formaldehyde- free hair straightening products are hair smoothening solutions widely used by professional beauty salons. Formaldehyde-free hair straighteners do not technically contain formaldehyde, however they contain other chemicals such as glyoxyloyl carbocysteine which releases formaldehyde upon contact with heat. Moreover, its by-product glyoxylate may convert to oxalate, both compounds have potential nephrotoxic effect.

Case presentation: 41-year-old woman presented to the emergency room with weakness, nausea , vomiting and  stage three acute kidney injury according to Kidney Disease: Improving Global Outcomes acute kidney injury staging (KDIGO) shortly after exposure to formaldehyde - free hair straightening product, other causes of acute kidney injury were excluded such as preceding acute illness, drug history or others nephrotoxic agent exposure On physical examination the patient was pale, her vital signs were normal. The urine microscopy and serologic workup was not indicative. Kidney core biopsy reveal interstitial edema, acute interstitial nephritis and oxalate crystal nephropathy. Kidney function completely recovered after a short course of steroid therapy.

Conclusions: We present a case of severe kidney injury after exposure to hair straightening products branded as formaldehyde free but actually contain other chemicals products which release formaldehyde and other toxic chemicals when heated during the straightening procedure and  may cause systemic toxicity, particularly kidney injury. Different cosmetic products are widely in use, not all are under a tight regulation, and therefore it is important to raise the awareness of both medical teams and consumers of possible adverse health effects of different cosmetic products.

INTRODUCTION

Nephrotoxicity is defined as kidney injury due to toxic effects of chemicals. There are various forms of chemicals and drugs that may affect renal function in various mechanism including acute tubular necrosis (ATN), tubulopathy and electrolyte imbalance, acute interstitial nephritis (AIN), glomerular damage, crystal nephropathy, and thrombotic microangiopathy [1-3].

Formaldehyde- free hair straightening products contain potentially toxic chemicals other than formaldehyde. One potential such substance is glyoxyloyl carbocysteine, which is composed of glyoxylic acid, cysteine and acetic acid. Glyoxylic acid both releases formaldehyde when heated and is converted into either glycine by AGT1 (alanine:glyoxylate aminotransferase 1) or oxalate by glycolate oxidase in the human cell peroxisomes [4].

Formaldehyde is a colorless aldehyde poisonous gas at room temperature [5]. It is usually mixed with water and when the small fraction of soluble formaldehyde reacts with water, it quickly forms methylene glycol. For every molecule of free formaldehyde, 1,820 molecules of methylene glycol are formed [6]. Methylene glycol reverts back to free formaldehyde almost immediately upon contact with air or skin. Formaldehyde is thus absorbed through skin, eyes, and inhalation, and is eliminated through the urine [7-8]. During the hair straightening process, high levels of formaldehyde are found in samples of air taken from beauty salons [9] and in specimens of hairstylist workers skin [10-11].

In the kidney, formaldehyde has been reported to cause direct cytotoxic effect resulting in acute toxic tubular necrosis [12-13], and may also cause an immune system response leading to acute interstitial nephritis.

Another potential nephrotoxic component of hair straightening products is oxalate, which is an end product of glyoxylic acid.  Increased levels of oxalate promote calcium oxalate precipitation in various tissues including the kidneys, resulting in toxic injury.

CASE PRESENTATION

A 41-year-old woman with a history of hypothyroidism and sleeve gastrectomy five years ago, presented to the emergency department with profound weakness, nausea and vomiting. Her symptoms began three days earlier, immediately after using a professional hair straightening formaldehyde- free product in a professional beauty salon.

On physical examination the patient was pale, her vital signs were normal, heart rate  was 66 bpm, blood pressure was 125/70 mmHg, she had no fever or respiratory distress and appeared euvolemic.

Laboratory investigations revealed a serum creatinine of 3.46 mg/dl (one year prior to the event Cr. value was 0.6 mg/dl), urea 77 mg/dl, and electrolytes, liver function tests, Beta human chorionic gonadotropin (β-hCG) and complete blood count were normal. Blood venous gases revealed: pH 7.375, HCO3 21 mmol/L and base excess 3 mmol. The anion gap and serum osmolar gap were normal. Urinalysis demonstrated leukocyturia +1 without hematuria or proteinuria.

During hospitalization urine output was normal, repeat urinalysis demonstrated leukocyturia +1 without hematuria or proteinuria, and Bence-Jones protein was negative. Urine microscopy demonstrated epithelial cells with few white blood cells without any casts or crystals. Renal ultrasound showed 14.4 cm bilateral echogenic, edematous renal parenchyma (shown in  Fig. 1).

A full serologic workup including hepatitis B and C, Human immunodeficiency virus (HIV), syphilis, antinuclear antibody (ANA) , Anti-double stranded DNA, Antineutrophil cytoplasmic antibody (ANCA), Anti-Phospolipid antibody (APLA) was normal except for a complement C3 level of 80 mg/dl (normal range 90-110 mg/dl).

On the 4th hospitalization day a renal core biopsy was performed. The histologic examination (shown in Fig. 2) was correlatd with  acute tubular necrosis, tubulo- intersitial nephritis and oxalate crystals . With the diagnosis of interstitial nephritis, the patient was started on prednisolone 1 mg/kg, one week later serum creatinine decreased to a level of 0.98 mg/dl.

Figure 1: Bilateral enlarged kidneys (14.4 cm) with echogenic, edematous parenchyma.

Figure 2: Kidney core biopsy: Hematoxylin and eosin staining; A: Glomeruli were normo-cellular and without signs of active glomerular disease (arrow heads), tubules showed signs of diffuse tubular injury (black arrow) and tubules contained oxalate crystals (blue arrow). B:The interstitium showed edema associated with multifocal mixed inflammatory infiltration with multiple eosinophils and foci of tubulitis. C:There was one epithelioid granuloma. D:Tubules contained oxalate crystals (blue arrow) observed under polarized light-microscopy. Immunofluorescence analysis revealed C3 1+ in blood vessel walls only.

DISCUSSION

This patient presents an unusual case of kidney toxic and inflammatory injury accompanied with oxalate deposition secondary to hair straightening product. In a literature review, only few cases [14-15] of acute kidney injury (AKI) following hair straightening formaldehyde- free product exposure were reported. All cases were reported after 2019. The spectrum of kidney injury following hair straightening ranges from mild to severe kidney injury requiring renal replacement therapy. The histopathologic changes reported mainly depicted severe acute tubular necrosis and acute interstitial nephritis.

Our patient presented with stage 3 AKI following hair straightening formaldehyde - free product exposure. Other causes of AKI were excluded such as preceding acute illness, drug history or other nephrotoxic agent exposure. Laboratory workup revealed leukocyturia +1, and ultrasonography was significant for enlarged edematous echogenic renal parenchyma. Kidney biopsy demonstrated acute interstitial nephritis, oxalate crystal precipitation and acute tubular necrosis. We speculate that the clinical presentation and the histopathologic changes directly resulted from exposure to the hair straightening formaldehyde- free product.

In reviewing the ingredients of the specific product used in this case, it included glyoxyloyl carbocysteine, glyoxyloyl keratin amino acid, propylene glycol glycerin, phenoxyethanol, ethylhexylglycerin disodium and other collagen, surfactant and fragrance components. We did not find evidence in the medical, pharmacological and chemical literature that any of these substances causes acute kidney injury other than glyoxyloyl carbocysteine.

Many hair straightening products are labeled as formaldehyde "free" but actually contain chemicals such as glyoxyloyl carbocysteine or methylene glycol which release formaldehyde and other toxic chemicals when heated, e.g the carbocysteine hair treatment represents the combination of glyoxylic acid + cisteine + acetic acid. Glyoxylic acid contains an aldehyde functional group, glyoxylic acid behaves as an aldehyde by  heating during the hair straightening process thus releasing high levels of formaldehyde gas exceeding the capacity of exposure[16]. On top of that, glyoxylic acid absorbed through the scalp may had converted to oxalic acid [17] which may precipitate in kidney tissue. It is possible that other components such as propylene glycol may cause osmotic renal injury. In this case, serum osmotic gap was not available since it calculated four days after exposure.

CONCLUSION

In conclusion, a case of severe kidney injury after exposure to hair straightening products branded as formaldehyde free is presented. This case highlights the sensitivity of the kidney to various environmental and commercial products, some of which have not been fully characterized or identified yet.

It is important to raise the awareness of both medical teams and consumers, of possible adverse health effects of different cosmetic products, including acute kidney injury, and perhaps promote tighter regulation of such products.

Statement of Ethics:

Ethical approval is not required for this study in accordance with local or national guidelines.

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available.

Conflict of Interest interests

The authors have no conflict of interest to disclose

Funding

No funding was obtained for this study.

Authors’ contributions

NAA, NZ, SM, PB, were involved in the clinical management of the patient.

NAA, MK, collected the data and wrote the first version of the manuscript.

NAA, NZ, MK, SM, PB approved the final version of the manuscript.

The authors read and approved the final manuscript.

Data Availability

All data that support the findings of this study are included in this article

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

[marccurelab]

Bladder or urethra is referred to as Urinary Tract Infection (UTI).

Some of the signs encompass burning sensation all through urination, cloudy or bloody urine, multiplied frequency and urgency of urination and pelvic pain. With natural and herbal supplements, you can without problems deal with UTI besides inflicting any side-effects. Ayurvedic drugs for urine infection, such as triphala, helps in relieving UTI. Women are at an increased chance of creating a UTI than are men. Infection restrained to your bladder can be painful and annoying. However, serious consequences can take place if a UTI spreads to your kidneys.

C-Berry is developed on a modern & advanced method of natural and carbohydrate. They use Cranberry extract and D-mannose. It will increase the fitness and feature of the Urinary Tract. C-Berry helps in keeping ordinary urine PH. It eases waste elimination.

[hmandirola-blog]

Las causas de la #hematuria incluyen entre otras, el ejercicio intenso y la actividad sexual. Las causas más graves de la hematuria incluyen cáncer de riñón o de vejiga; inflamación del riñón, la uretra, la vejiga o la próstata; y enfermedad poliquística del riñón, entre otras. https://www.instagram.com/p/CkS1VEoOgVW/?igshid=NGJjMDIxMWI=

[urologymagazinetoyou]

SANGRE EN LA ORINA - HEMATURIA El sangrado en la orina es la manifestación más común del cáncer de vejiga. Suele presentarse como único síntoma, sin asociarse a otras molestias urinarias o dolor por lo que se le conoce clínicamente como Hematuria monosintomática. Cuando se objetiva el sangrado, el riesgo de padecer una enfermedad urológica es de un 50 % siendo una de las causas fundamentales el cáncer de vía urinaria, por lo que el estudio de este síntoma es mandatorio. Tras el estudio, hasta en un 20 % de los pacientes se demostrará un cáncer de vejiga. Por rango de edad, hasta en un 34 % de las personas mayores de 50 años y hasta un 10 % de los menores de 50 años padecerá de este tipo de cáncer. El estudio de la hematuria incluye: -Cistoscopia para valorar la uretra y la vejiga. -Tomografía Urológica para el estudio de la vía urinaria alta y valorar extensión tumoral -Citología de orina para el estudio de las células vesicales -Analítica sanguínea que puede incluir el PSA -Sedimento de orina - Cultivo de orina Si quiere saber más sobre este y otros temas urológicos, visitanos en nuestras redes. MADRID UROLOGIA Consultas 100 % privadas. Sin esperas. Sin riesgos. 📍 Calle del Corazón de María 23. Primero B. Madrid. 📨 consultas@madridurologia.com 📞910 32 73 74 📱656727747 #madridurologia #cancerdevejiga #hematuria #robotdavinci #cistoscopia #laparoscopiavejiga #cirugiacancervesical #consulturologia (en Madrid Urologia. Pagina Oficial) https://www.instagram.com/p/Cj_U8aEoZYJ/?igshid=NGJjMDIxMWI=

[mcatmemoranda]

I've never heard of "march hemoglobinuria." It's hemoglobinuria due to excessive running.

March hemoglobinuria, occurs when hemoglobin is seen in the urine after repetitive impacts on the body, particularly affecting the feet. The word "march" is in reference to the condition arising in soldiers who have been marching for long periods; the condition was first documented in 1881.

Mechanical hemolytic anemia is a form of hemolytic anemia due to mechanically induced damage to red blood cells. Red blood cells, while flexible, may in some circumstances succumb to physical shear and compression.[1] This may result in hemoglobinuria. The damage is induced through repetitive mechanical motions such as prolonged marching (march hemoglobinuria) and marathon running. Mechanical damage can also be induced through the chronic condition microangiopathic hemolytic anemia or due to prosthetic heart valves.

Intact RBCs on urine microscopy excludes myoglobinuria and hemoglobinuria.