Hematuria - Blood in the Urine

Hematuria is a condition in which blood appears in a patient’s urine. The blood may be gross (visible to the naked eye) or microscopic (only visible under a microscope). Hematuria can originate from any location along the urinary tract. Most of the time, the cause of hematuria is not serious. But, never ignore blood in the urine. Your doctor can evaluate you to find the cause of the bleeding and treat it, if needed. Common risk factors for the condition include, tobacco use, radiation, overuse of certain pain medication and certain chemicals.

There are two types of hematuria

  • Gross hematuria means that the blood can be seen by the naked eye. The urine may look pinkish, brownish, or bright red.
  • Microscopic hematuria means that the urine is clear, but blood cells can be seen when urine is looked at under a microscope or tested in a lab.

Both types of hematuria can have the same causes. Neither one is necessarily more serious than the other. With either type, you may have other symptoms, such as pain, pressure, or burning when you urinate, abdominal pain, or back pain. Or, you may not have any other symptoms. No matter how much blood is found, the cause of the bleeding needs to be identified.

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Causes & Risk Factors of Hematuria

Hematuria can occur as a result of certain conditions, including:

  • Bladder cancer
  • Kidney cancer
  • Prostate cancer
  • Ureteral cancer
  • Urethral cancer
  • Urinary stone disease
  • Urinary tract infection
  • Pyelonephritis (kidney infection)
  • Benign Prostatic Hyperplasia (enlarged prostate)
  • Renal disease
  • Radiation or chemically induced cystitis (inflammation of the bladder)
  • Urinary tract injury
  • Prostatitis (prostate infection)
  • Exercise hematuria (jogger’s hematuria)

In addition to blood in the urine, the following symptoms may also be present with hematuria:

  • Abdominal pain
  • Pain in the flank or side
  • Urinary difficulty
  • Frequent or urgent urination
  • Painful urination
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Diagnosis

Usually a patient sees blood in the urine and seeks medical attention.
In instances of microscopic blood in the urine, diagnosis begins with a urine dipstick test. If the test comes back positive for blood, the urine is observed under a microscope. If three or more red blood cells are seen per high power field on two of three microscopic specimens, the patient’s urinary tract is evaluated further to determine the cause of the condition. This evaluation typically consists of a urinalysis and a microscopic urine examination to determine signs of kidney disease, urinary tract infection and the location of the bleeding. Patients may also undergo a urinary cytology test to observe abnormal cells in the urine and a blood test to measure elevated serum creatinine levels.

Other tests used to evaluate hematuria may include:

  • History and physical exam
  • X-rays (including intravenous pyelogram (IVP)
  • Lab tests may include urinalysis, a urine culture, a urine cytology, and various blood tests
  • Cystoscopy
  • Computed tomography (CT) or CT urography
  • Magnetic resonance imaging (MRI) or MR urography
  • Ultrasound of the kidney
  • Kidney biopsy

Causes of hematuria include the very benign (exercised induced hematuria) to the very severe (cancer of the urinary system). A variety of treatments are available depending on the cause.

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