Exercise-induced hematuria Traumatic – 病因： Direct trauma to the kidneys and/or bladder – long-distance running 會傷害 bladder Nontraumatic – ischemia due to shunting of blood to exercising muscles

Hemoglobinuria & Myoglobiuria B 許瑜真

Hemoglobinuria 之成因 ( 血色素尿 ) Burns Renal cancers Malaria Paroxysmal nocturnal hemoglobinuria Hemolytic-uremic syndrome (HUS) Pyelonephritis Sickle cell anemia Transfusion immune reaction Thrombotic thrombocytic purpura (TTP) Tuberculosis of the urinary tract (X) (X) (X) (X) (X) (X) (X)

Pyelonephritis 症狀：發燒，嘔吐，後腰疼痛 診斷：尿檢 WBC↑ 、尿液培養 >100,000 CFU/ml Acute pyelonephritis, APN – 病因 : 細菌感染， >80% 為 E. coli ，女性較常見 – 腎臟腫大 Chronic pyelonephritis, CPN – 病因 : 阻塞 (BPH 、結石 ) 、膀胱尿液逆流 – 腎臟萎縮

Tuberculosis of the urinary tract 症狀：排尿困難、血尿 診斷： skin test

Myoglobinuria ( 肌紅素尿 ) Trauma Venom( 毒液 ) 特殊藥物 Rhabdomyolysis Muscle destruction Myoglobin 大量釋放 (X) (X) (X)

Rhabdomyolysis 症狀：肌肉痛、肌紅素尿、血中 CK↑ 病因： – Trauma or muscle compression – Nontraumatic exertional rhabdomyolysis – Nonexertional and nontraumatic rhabdomyolysis

Trauma or muscle compression Victims of multiple trauma Individuals struggling against restraints, torture victims, or abused children Immobilization due to coma of any cause or in conscious individuals forced to lie in one position for hours Surgical procedures Acute lower extremity compartment syndrome

Nontraumatic exertional rhabdomyolysis Untrained people – Exertion occurs in extremely hot, humid conditions Metabolic myopathies – Hypokalemia caused by potassium loss from sweating Malignant hyperthermia Neuroleptic malignant syndrome Near drowning/hypothermia

Nonexertional and nontraumatic rhabdomyolysis Drugs and toxins Infections Electrolyte disorders – hypokalemia – Hypophosphatemia Endocrine disorders Inflammatory myopathies