THE URINE 40I 



Haematuria. By this we mean the presence of red blood cells in 

 the urine, and the condition is of ten recognizable only by microscopic 

 or occult blood examinations. It is better to separate this condition 

 from haemoglobinuria. Origin may be renal, cystic, urethral, ureteral 

 and secondary to disease or traumatism. It may also result from 

 affections of structures adjacent to the genito-urinary apparatus, 

 especially ulcerations of the large intestines (amoebic), or from disease 

 of the female generative apparatus as uterus, vagina or tubes. 



In certain general diseases, as smallpox, purpura, and leukemia one may expect 

 hagmaturia. In the tropics it is a finding in yellow fever (asthenic stage) and in 

 plague as well as in bilharziasis and haematochyluria of filariasis. 



Haemorrhage from the kidneys may arise from malignant growths, especially 

 hypernephroma, or from benign ones, as papilloma of the pelvis. 



Haematuria occurs not only in acute nephritis but in some chronic 

 cases. Chronic passive congestion is associated with red cells in the 

 urine and renal infarctions from endocarditis may also bring it about. 



Stone in the pelvis of the kidney is an important cause. In the bladder we have 

 as chief causes (i) tumors, malignant or innocent, and (2) calculus. In tumors 

 the bleeding is not markedly controlled by rest as is that from stone. 



In the urethra gonorrhoeal inflammation, especially when near the neck of the 

 bladder, and traumatism may be associated with hsematuria. 



Haemoglobinuria. The two diseases one always thinks of in con- 

 nection with haemoglobinuria are blackwater fever and paroxysmal 

 haemoglobinuria. It is discussed under tests for transfusion. 



Bacteriuria. Bacterial infections of the genito-urinary tract are 

 associated with more or less pyuria. Kidney infections are now 

 recognized as most often from the blood stream rather than from 

 extension from portions of the tract lower down. 



The most important hsematogenous bacterial infections of the kidney are, in 

 order of frequency, colon bacillus, staphylococci, streptococci, gonococcus, proteus, 

 typhoid and paratyphoid. Renal tuberculosis is generally haematogenous rather 

 than an ascending infection. Very important is the differentiation of the pyuria 

 of cystitis and pyelitis. Of course bladder irritation will follow pyelitis. 



The use of two sedimentation glasses will differentiate pus from the urethra from 

 that from bladder and pelvis of kidney. If the urine in the first glass alone is turbid 

 it shows urethral pus. With cloudiness of the contents of the second glass the 

 problem is more difficult because it is almost impossible to differentiate a bladder 

 involvement from a renal one by microscopic examination. Cystoscopy is necessary. 

 Of course, some authorities attach importance to the character of pelvis epithelium, 

 others to the acid urine of pyelitis and the alkaline one of cystitis. Again it is 

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