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A case report of patient presenting with Red urine

A case report of patient presenting with Red urine

A case of gross haematuria has been reported by  Alexandre Le Joncour of Université Pierre et Marie Curie, Paris, France which has appeared in BMC Nephrology.

A 35-year-old non-smoking African man was admitted for a renal biopsy.

His medical history was of recurrent multiple sclerosis, identified 3 years previously and limited to loss of sensation of the extremities. Since diagnosis, he had been treated with a sphingosine 1-phosphate modulator. He was receiving no other treatment.

Two weeks after a common dental procedure, he experienced a sudden onset of painless, profuse and persistent gross hematuria. He did not take any medication such as a non-steroid anti-inflammatory drug or antibiotics. There were no other urinary symptoms, sore throat, skin rash, abdominal pain or bone pain. Physical examination revealed no abnormalities except gross hematuria without clots. Laboratory tests are shown in Table 1. Abdominal ultrasonography and excretory-phase computed tomography angiography revealed no renal abnormalities; the bladder appeared pristine under cystoscopy. Given these findings, the origin of the hematuria was obscure. Significant proteinuria (around one gram per day) was found, and the patient was referred to a nephrologist for a renal biopsy in order to rule out glomerulopathy. However, the biopsy was not performed since a simple blood test established the diagnosis.

Indeed, hemoglobin electrophoresis revealed a sickle cell trait (HbAS) with 62% HbA and 34% HbS, respectively. The diagnosis of renal papillary necrosis or microscopic renal papillary necrosis with macroscopic hematuria related to sickle cell trait was made.

The patient was treated with oral alkaline hydration and gamma epsilon-aminocaproic acid. Urine was clear of hematuria after 2 weeks of treatment and there was no recurrence after 1 year.

Generally, Gross hematuria in young adults requires a complete work-up, including renal imaging with ultrasound, computed tomography angiography, cystoscopy and microbiological tests to rule out renal obstruction, kidney stones, renal infarction, schistosomiasis, other infections, toxic/herbal consumption and urological tumors. Renal biopsy is then often needed to explore glomerulopathies such as IgA nephropathy. Sickle cell trait may have some renal complications and can present as gross haematuria but the baseline rate of admission for gross hematuria in normal males carrying the sickle cell trait is only 2%.

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Source: BMC Nephrology

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