Hematuria

Hematuria is blood in the urine. Two types of blood in the urine exist:

• Gross hematuria. Blood can be seen when looking at the urine with the naked eye.
• Microscopic hematuria. Urine looks clear, but red blood cells (RBCs) can be seen when the urine is examined under a microscope.

Hematuria can be a warning sign of a more serious condition. Blood in the urine can come from structures in the urinary tract, such as:

• Kidneys (which filter blood and where urine is created),
• Ureters (tubes that transport urine from the kidneys to the bladder),
• Bladder (which holds the urine), and
• Urethra (which carries urine from the bladder out of the body).

In men, blood in the urine can also come from the prostate, which surrounds the urethra.

Sometimes, what appears to be blood in the urine is actually red pigment from other sources such as food dyes, medications, or an excessive amount of beets or rhubarb. Liver diseases can also darken the urine, as can dehydration when the urine is very concentrated.

• Gross hematuria symptoms include urine that is pinkish, brownish, or bright red. Even a small amount of blood in the urine can cause this color change. There are usually no other symptoms, but pain may occur if the urine includes blood clots.
• Microscopic hematuria generally does not cause symptoms.

Hematuria can be caused by menstruation, vigorous exercise, sexual activity, viral illness, trauma, or infection, such as a urinary tract infection (UTI) or a recent “strep” (streptococcal) infection. Some medications may also cause hematuria, as can catheter use or prior radiation to the pelvis or prostate. More serious causes of hematuria include:

• Cancers including but not limited to prostate cancer, bladder cancer, and cancers of the ureter or kidney.
• Inflammation of the kidney, urethra, bladder, or prostate.
• Prostate enlargement (benign prostatic hyperplasia or BPH).
• Bladder or kidney stones.
• Polycystic kidney disease.
• Blood clots.
• Blood clotting disorders, such as hemophilia.
• Inherited diseases such as sickle cell anemia and cystic kidney disease.
• Systemic lupus erythematosus (the chronic inflammatory disorder of connective tissue).
• A kidney injury from an accident or sports

• Having a personal history of bladder or other urothelial cancer.
• Having a family history of bladder cancer.
• Having certain changes in genes linked to bladder cancer.
• Being exposed to paints, dyes, metals, or petroleum products in the workplace.
• Past treatment with radiation therapy to the pelvis or with certain anticancer drugs, such as cyclophosphamide or ifosfamide.
• Taking Aristolochia Fang Chi, a Chinese herb.
• Drinking water from a well with high levels of arsenic.
• Drinking water treated with chlorine.
• Not drinking enough fluids, especially water.
• Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
• Using urinary catheters for a long time.
• Rare bladder birth defects.

Hematuria can occur in almost anyone, including children.  Risk factors for hematuria include:

• A family history of kidney disease.
• An enlarged prostate.
• Urinary stone disease.
• Certain medications, including aspirin and other pain relievers, blood thinners, and antibiotics.
• Strenuous exercise, such as long-distance running.
• A recent bacterial or viral infection.

1. Urinalysis. A sample of your urine is taken. First, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when RBCs are present in urine. If RBCs are found, a health care provider examines the urine with a microscope to make an initial diagnosis of hematuria. Further testing of the urine may be done to check for problems that can cause hematuria, such as a UTI, kidney disease, and cancer.

2. Medical History. Tell your health care provider about your symptoms, how long you’ve had them, and how they affect your everyday living. Bring a list of your over-the-counter and prescription drugs. Tell your provider about any past and current health problems. If your medical history suggests a cause that does not require treatment, the urine should be tested again after 48 hours for the presence of RBCs. If two of three urine samples show too many RBCs when viewed with a microscope, more serious causes should be explored. The health care provider may order one or more of the following tests:

3. Blood test. A blood test can show the presence of high levels of creatinine, a waste product of normal muscle breakdown, which may indicate kidney disease.

4. Cystoscopy. A hollow tube called a cystoscope is inserted into the urethra (the tube that carries urine out of the body) and then into the bladder. The lens in the cystoscope allows a doctor to examine the bladder lining. Cystoscopy may be used to look for an abnormality within the bladder, particularly if cancer cells are found with urinalysis.

5. Kidney imaging tests, ultrasound, CT scan, or magnetic resonance imaging (MRI).

Hematuria is a symptom and not a specific condition, so there is no standard treatment for it. Instead, hematuria is treated by treating its underlying cause.