La hematuria microscópica es más común de lo que se cree.

Muchos pacientes son remitidos a nuestras consultas por tener una mínima presencia de sangre en el análisis de orina ( hematuria) , aunque ellos nunca hayan observado ningún sangrado al orinar. Técnicamente, se produce cuando se detectan más de 3 glóbulos rojos por campo en la orina. El número de personas en la población que lo tiene es muy variable y, dependiendo de los estudios, puede oscilar entre un 2 y un 20% de los pacientes estudiados. Esta alta prevalencia se debe a que el ejercicio físico o la actividad sexual tienen un papel determinante en la presencia de estos hematíes en la orina. Es característico que después de practicar ciertos deportes, como correr o los deportes de contacto, pueda aparecer sangre en la orina; por ejemplo, tras una maratón una gran proporción de corredores tiene microhematurias.

Las principales enfermedades que se deben descartar son las que alteran el funcionamiento de la filtración del riñón. En todos los casos, hay que desestimar un tumor de la vía urinaria desde el riñón, la vejiga o la próstata. Otra causa frecuente son las piedras en el riñón o infecciones de orina. En los hombres que tienen hiperplasia benigna de próstata, es frecuente esta situación. Hay que investigar también si el paciente está bajo tratamiento anticoagulante, ya que facilita el sangrado.

Las pruebas diagnósticas a realizar son: análisis de sangre completo con función renal; ecografía urológica para descartar tumores en el riñón, la vejiga, y además mide el tamaño de la próstata; TAC urológica con contraste que descarte neoplasias uroteliales (técnica de elección con una sensibilidad muy alta);y cistoscopia, se introduce un dispositivo con una cámara incorporada que permite visualizar toda la uretra, vejiga y próstata.

En la gran mayoría de los casos, no encontramos evidencias de ninguna enfermedad, aunque siempre debe realizarse un estudio.

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