Hematuria (Blood in Urine) - Dr. Nikolaos Mertziotis Urologist Athens

What is hematuria?

Hematuria is the presence of blood in the urine of a person. There are two types of hematuria:

• Gross hematuria - when a person can see traces of blood in the urine or a greater amount of blood in their urine.
• Microscopic hematuria - when a person cannot see blood in their urine, however it is seen through a microscope.

What causes hematuria?

Reasons why people may have blood in the urine include:

• infection in the bladder, kidneys or prostate
• trauma
• vigorous exercise
• viral diseases, such as the hepatitis-a virus that causes liver disease and inflammation of the liver
• sexual activity
• Menstruation
• endometriosis - a problem in women that occurs when the type of tissue normally present in the uterus grows somewhere else, such as the bladder

The most serious causes of hematuria are:

• bladder or kidney cancer
• inflammation of the kidney, urethra, bladder or prostate - a walnut-shaped gland in men that surrounds the urethra and helps create sperm
• blood clotting disorders, such as haemophilia
• sickle cell anemia - a genetic disorder in which a person's body makes abnormal red blood cells
• polycystic kidney disease – a genetic disorder in which many cysts develop in a person's kidneys

Chances of developing hematuria

People who are more likely to develop hematuria can,

• have an enlarged prostate
• have urinary stones
• take certain medicines, including blood anticoagulants (blood thinners), aspirin and other painkillers, and antibiotics
• do strenuous exercise, such as running long distances
• have a bacterial or viral infection, such as strep or hepatitis
• have a family history of kidney disease
• have a disease or condition affecting one or more organs

What are the symptoms of hematuria?

People with heavy hematuria have urine of pink, red or brown color. Even a small amount of blood in the urine (a few drops) can cause the color of the urine to change.

In most cases, people with severe hematuria have no other signs and symptoms. People with severe hematuria involving blood clots in the urine (clotting) may have bladder pain or pain in the back (kidney area).

How is hematuria diagnosed?

The doctor can diagnose hematuria or the cause of hematuria by

• medical history
• clinical examination
• urinalysis
• additional tests

The clinical examination must include the following:

Digital rectal examination.

A digital rectal examination is an examination of the prostate and rectum. Digital rectal examination is used to check for inflammation of the prostate, an enlarged prostate, or prostate cancer.

Gynecological examination.

A gynecological exam is a visual and clinical examination of a woman's pelvic and genitals to check for problems that may be causing blood in the urine.

Urinalysis

The doctor may examine the urine in the office using a measuring rod (urine stick) or may send it to a laboratory for analysis. Sometimes urine tests using a weight dipstick can be positive, even though the patient has no blood in the urine, which leads to a "false positive" test. The doctor can look for red blood cells by examining urine under a microscope before ordering further tests.

Before taking a urine sample, the doctor may ask a woman when she had her last menstrual period. Sometimes blood from a woman's period can get into the urine sample and lead to a false positive test for hematuria. The examination should be repeated after the woman stops menstruating.

Additional tests

Sometimes, a doctor will check the patient's urine again. If urine samples detect too many red blood cells, the doctor may order additional tests:

• Blood test.
• Computed tomography (CT).
• Cystoscopy. A cystoscopy can detect cancer in a patient's bladder.
• Renal biopsy. A biopsy can help diagnose whether hematuria is due to kidney disease.
• Magnetic resonance imaging (MRI). An MRI scan can help diagnose problems in individual internal organs, such as the bladder or kidney.

Confrontation

The general principles of treatment are as follows:

• Hematuria is a sign and not a disease itself. Thus, treatment should be directed to the cause that causes it.
• Asymptomatic (isolated) hematuria generally does not require treatment but needs investigation.
• In situations related to abnormal clinical, laboratory or imaging studies, treatment may be required, as appropriate;
• Surgery may be necessary with certain anatomical abnormalities (eg obstruction of the ureteropelvic junction, tumor or significant urolithiasis).
• Dietary modification is usually not indicated, except in children who may tend to develop hypertension or edema as a result of the initial diagnosis of the disease (eg nephritis).
• Patients with persistent microscopic haematuria should be monitored every 6-12 months for signs or symptoms indicative of progressive kidney disease.

Food and nutrition

Researchers have not found that food consumption and diet do not play any role in causing or preventing hematuria.

Hematuria