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Hematuria Educational Brochure
Hematuria is an abnormal presence of blood in the urine. There are two forms of hematuria. When the urine is visibly pink or red, it is “gross hematuria”. When the urine looks normal, but blood is seen under the microscope, it is “microscopic hematuria”.
Causes of Hematuria
There are many causes of hematuria. “False hematuria” is a discoloration of the urine from pigments such as food coloring or myoglobin. “Fictitious hematuria” is the presence of blood cells in the urine from a source outside the urinary such as vaginal bleeding. Kidney disease such as glomerulonephritis often causes blood and protein on the urine.
The most common causes of significant hematuria are infections, kidney stones, trauma and tumors. These lesions are more likely to bleed in patients on blood thinners, aspirin and nonsterodial inflammatory medicine such as ibuprofen. Also, the likelihood of significant lesions increases steadily with age, with a sharp increase after 50. Bladder cancer is more common in people who smoke. Studies of hematuria have shown that life threatening conditions are found in 10%, significant disease requiring treatment in 10%, significant causes that could be observed in 15% and insignificant causes in 55%.
- Blood in the urine can come from anywhere along the urinary tract:
Kidneys
- Ureters (tubes connecting the kidneys to the bladder)
- Bladder
- Prostate (in men)
- Urethra (tube draining the urine out of the body)
Evaluation
The standard evaluation of hematuria consists of:
- Detailed history and physical.
- Urine Specimen to confirm the presence of blood and look for signs of infection.
- Urine culture and sensitivity to show if the urine is infected, and to determine that specific bacteria and appropriate antibiotic for treatment.
- Blood tests involving a complete blood count (CBC) and a medical profile.
- Urine Cytology to evaluate the urine for cancer cells.
- IVP (Intraveneous Pyelogram), which is an x-ray of the urinary tract (kidneys, ureters, bladder). It involves the injection of a special substance called contrast which is filtered by the kidneys and helps visualize the urinary tract. Some patients may be allergic to contrast and a different imaging method must be used.
- Cystoscopy - This procedure allows the doctor to directly examine your urethra and bladder. This is accomplished by looking through a small, telescope-like tube. Cystoscopy is usually done in the office under local anesthesia.
Treatment
The proper treatment for hematuria depends on the cause. A small amount of blood can turn the urine bright red, and hematuria rarely requires a blood transfusion. Severe gross hematuria with clots requires immediate attention and evaluation. Most hematuria does not require an emergency evaluation. Hematuria from an infection should be treated with antibiotics. Blood in the urine from a stone or tumor should be treated by addressing that problem. In “idiopathic hematuria,” which occurs in as many as 20% of hematuria patients, no cause can be determined. These patients should be followed every 6-12 months with a urinalysis and history to see if symptoms change.
Summary
Blood in the urine is a warning signal that should not be ignored. A thorough evaluation is necessary. If the cause is something serious, your physician wants to make a diagnosis and begin proper treatment.
References
- Walsh, Retik, Stamey and Vaughan: Campbell’s Urology, 1992.
- Gillenwater, Grayhack, Howards and Puckett: Adult & Pediatric Urology, 1991.
- Abuelo, M.D., J. Gary: Evaluation of Hematuria, Urology 1983, vol. 21; p. 215
- Cilento, B.G. et al: Hematuria in Children, A Practical Approach, Urologic Clinics of North America, February 1995, p. 43-55.
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