Idiopathic renal hemorrhage

Japanese: 特発性腎出血 - とくはつせいじんしゅっけつ（英語表記）Idiopathic renal hemorrhage
Idiopathic renal hemorrhage

What is the disease?

Idiopathic renal hemorrhage is bleeding from the kidneys to the urinary tract for an unknown reason. Macroscopic hematuria (bright red urine) continues for several hours to several days. Although it is bleeding from the kidneys, blood does not accumulate in the body. It is often seen in relatively young people in their 20s and 30s.

By the way, "idiopathic" means "unknown cause." There is a similar word, "idiopathic," which means "suddenly."

In addition, renal bleeding due to the nutcracker phenomenon (column) was previously classified as idiopathic renal bleeding, but since the cause has been identified, it is no longer included.

How symptoms manifest

Bright red urine appears suddenly without any cause or trigger, so it is often surprising. It may happen only once, but it may continue for several days. It may also recur. In many cases, you will need to see a urologist.

Not all cases of bright red urine are due to idiopathic renal bleeding. Other causes include urinary tract infection (such as cystitis), Urinary tract stones ( Nyoro examination ) (Ureteral stones, etc.), malignant tumors of the urinary tract (bladder cancer, etc.), Glomerulonephritis ( Emergency response team ) (Acute glomerulonephritis, IgA nephropathy, etc.) Foreign bodies in the urinary tract ( Animals ) Some examples include:

Testing and diagnosis

It is necessary to exclude other causes of gross hematuria. Specific tests include urine sediment, urine cytology, urine bacterial culture, ultrasound, CT, MRI, and intravenous Renal pelvis ( Jinu ) We perform imaging (IVP), cystoscopy, etc. By excluding other causes, we can diagnose idiopathic renal bleeding.

Treatment methods

Drug therapy includes hemostatic drugs such as antiplasmin drugs. If gross hematuria persists, silver nitrate is also injected into the renal pelvis using a ureteral catheter.

What to do if you notice an illness

If other diseases have been ruled out, there is no need to panic. In most cases, it will disappear naturally. If it persists or recurs many times, you should visit a urologist for treatment. It is best to avoid drinking alcohol or strenuous exercise while you have visible hematuria.

Related Topics

Acute glomerulonephritis, chronic glomerulonephritis, kidney cancer, urinary tract stones, acute cystitis, bladder cancer

Mitsunori Tanigame

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　特発性腎出血とは、腎臓から尿路への原因不明の出血です。肉眼的血尿（真っ赤な尿）が数時間～数日続きます。腎臓からの出血といっても、体内に血液がたまるわけではありません。20～30代の比較的若年者に多くみられます。

　ちなみに「特発性」は「原因不明」という意味です。「突発性」という似たような単語がありますが、こちらは「突然に」という意味です。

　なお、ナットクラッカー現象（コラム）による腎出血は、以前は特発性腎出血に含まれていましたが、原因が明らかになったので、現在では含まれません。

症状の現れ方

　原因や誘因がなく、いきなり真っ赤な尿が現れるため、びっくりしてしまうことが多いようです。一度だけの場合もありますが数日間続くこともあります。また、再発することもあります。多くの場合、泌尿器科を受診することになります。

　真っ赤な尿のすべてが特発性腎出血ではありません。他の原因としては、尿路感染症（膀胱炎など）、尿路結石症(にょうろけっせきしょう)（尿管結石など）、尿路悪性腫瘍（膀胱がんなど）、糸球体腎炎(しきゅうたいじんえん)（急性糸球体腎炎やIgA腎症など）、尿路異物(にょうろいぶつ)などがあげられます。

検査と診断

　他の原因による肉眼的血尿を除外することが必要です。具体的な検査としては、尿沈渣、尿細胞診、尿細菌培養、超音波、CT、MRI、静脈性腎盂(じんう)造影（IVP）、膀胱鏡などを行います。他の原因を除外することにより、特発性腎出血と診断できます。

治療の方法

　薬物療法としては、抗プラスミン薬などの止血薬が使用されています。肉眼的血尿が持続する場合には、尿管カテーテルを用いて硝酸銀の腎盂内への注入も行われます。

病気に気づいたらどうする

　他の疾患が除外できたら、あわてる必要はありません。多くは自然に消失します。持続したり、何度も再発したりする場合には、泌尿器科を受診して治療を行います。肉眼的血尿が見られる間は、飲酒や激しい運動はひかえたほうがよいでしょう。

関連項目

　急性糸球体腎炎、慢性糸球体腎炎、腎がん、尿路結石症、急性膀胱炎、膀胱がん

谷亀　光則

出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

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