ILEMATLTRIA Htematuria may be defined as the excretion of urine containing blood. Its importance is purely symptomatic, since all conditions of either the excretory or the conducting apparatus, which may be at tended by hamorrhage, manifest themselves by bloody urine. A mis taken diagnosis due to the admixture of blood from some other source than the urinary apparatus may be avoided by thorough investigation.
According to the quantity of the admixture of blood the color may vary from slightly reddish to blood Tech Only by microscopic examina tion can the diagnosis of hcematuria be definitely- established, and the possibility of error due to some other coloring matter be eliminated.
Among the local causes of hiematuria in infancy. are to be men tioned, inflammatory diseases of the kidney (especially scarlatina] nephritis), trauma, stone, tuberculosis, tumors, embolic processes, and thrombosis of the renal vein, if it does not produce complete anuria.
Furthermore, we have to remember that the various forms of luemorrhagic diathesis may be attended by Inematuria, or even present this as the sole symptom (renal hremophilia, Senator). This is true of a special disease of infancy, infantile scurvy (Barlow's disease). A num ber of cases of this disease have been recorded in which the hirmaturia was the only symptom, and in which the bloody urine disappeared promptly under improved diet. It may be remarked that .in almost every case of infantile scurvy if the examination is sufficiently exhaus tive, blood corpuscles in greater or smaller ntunbers will be found in the urine (Heubner). Guthrie has described a congenital, hereditary, family form of thematuria, which affected twelve rocinbers of a family, who were not bleeders. The hremorrhag,e appeared in these persons especially after partaking of certain dishes.
Not infrequently it is difficult to determine the source of the bloocl, and to decide whether it comes front the renal parenchyma or from the urinary tract. In ffiemorrhage from the kidneys, unless due to injury of a large vessel, the blood and the urine are intimately mixed, and it is rare to see a coagulum settle to the bottom of the glass. An unerring sign that the haunorrhage comes from the kidney is the presence of blood casts (see the cut of sediments from scarlatina] nephritis). But besides these there will be found other casts and renal epithelium. According to Gumprecht, fragmentation of the red blood corpuscles, the finding of numerous microcytes in the urine, is always an indication that the hiemorrhage did not arise below the kidney. He believes that the harmorrhage is the result of the action of the urea on the blood plate lets. According to Heubner, the presence of numerous infinitesimal blood corpuscles in the urine in hiemorrhagic scarlatinal nephritis is due to the impossibility of the larger cellular elements passing through the crural arch.
Just as the prognosis in hiematuria depends upon the fundamental disease, so the therapy is governed by the cause. Haunorrhage from the kidneys demands absolute quiet, a diet free from spices, and the appli cation of the ice-bag. If the hannorrhage is more persistent, the internal application of gelatin, or the subcutaneous injection of rt 2 per cent. solution of gelatin is worth trying. In cases of renal }hemophilia I saw the bleeding arrested by this means. As a last resort extirpation of the bleeding kidney may be attempted. In a case of renal lhemophilia, Israel obtained a cure by peeling out and replacing the kidney.