Definition.—The presence of blood in the urine.
Etiology.—Hemorrhage from the kidney may be caused by severe acute or chronic hyperemia of the kidney, from nephritis and embolic infarctions due to ulcerative endocarditis. Malignant disease of the kidney, or tuberculosis of the organ, will also give rise to it, while the ingestion of large doses of turpentine, cantharides, and potassium chlorate, carbolic acid, and like remedies, is followed by hemorrhage. Injuries or blows over the kidneys are sometimes attended by severe bleeding. Stone in the ureter or bladder, or the passage of a small calculus through the urethra, may be the exciting cause. A severe cystitis is sometimes attended by hemorrhage. Certain diseases, like malaria and leukemia, may be attended by blood in the urine.
Some cases occur from unaccountable causes, and may be termed renal hemophilia. I have an interesting case, a "bleeder"—hemophilia—who bleeds from the slightest provocation, most frequently from the nose or gums, though on three different occasions the hemorrhage has been from the kidneys.
Symptoms.—There is a sense of fullness and weight in the loins, and sometimes pain of a dull, aching character. There is almost a constant desire to micturate, attended with tenesmus and burning. If the result of an injury, the pain may be intense and of a sickening character, with marked prostration. The pain may extend down the ureter to the penis or testicle.
Diagnosis.—The diagnosis is easily made as to the presence of blood in the urine, but it is not always easy to tell its source.
The color of the urine will vary from a smoky hue to a dark coffee color, and between which there may be every shade of red. The microscope will reveal the presence of red blood-corpuscles thus distinguishing it from hemoglobinuria, in which they are entirely absent. If the hemorrhage be from the kidney, the blood is apt to be more uniformly mixed with the urine, and there will often be cylindrical clots the shape of the ureter or mold of the kidney. If from the bladder, the first urine voided may be quite clear, or at least much lighter than the last portion. When the quantity of blood is very slight, the color may not be deep enough to reveal it, and reagents will have to be used to determine its presence.
At times the clotted blood may completely fill the bladder. If there be doubt as to the source of the hemorrhage a cystoscopic examination of the bladder, and catheterization of each ureter, will determine the location, and remove all doubt.
Prognosis.—This will depend entirely upon the cause: where the result of grave lesions, the prognosis will be unfavorable.
Treatment.—In acute hematuria, the patient should be placed in bed, a towel wrung out of cold water applied around the abdomen, the patient being warmly covered with blankets, and hot-water bottles placed to the feet. Internally, five-grain doses of gallic acid may be given every thirty or sixty minutes, or we may give five drops each of the oil erigeron and cinnamon, every ten, twenty or thirty minutes. Where the hemorrhage is more passive in character, hamamelis, hydrastis, or carbo vegetabilis may be given. Ergot should be given hypodermically in extreme cases. Should the heart's action be strong, as shown by the full, bounding pulse, veratrum should be administered.
Where the hemorrhage is due to congestion of the kidney or nephritis, means should be directed to overcoming these conditions, and such remedies as gelsemium, apis, eryngium, and rhus tox. will be useful. Also infusion of couch grass, marsh-mallows, haircap moss, and remedies of like character.