Hematuria - Blood in the Urine

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.