Experiencing blood in the urine is undoubtedly an extremely frightening and dramatic experience. Blood in the urine, or “hematuria”, can be treated if you seek immediate medical intervention by contacting a urologist.
Table of Contents
Feel free to skip ahead if one topic catches your eye:
- What is Hematuria?
- What are the causes of blood in urine?
- Who is at more risk of hematuria?
- Signs and Symptoms
- Tests and Diagnosis
- How is it Treated?
1. What is Hematuria?
Hematuria, a common symptom of both malignant and benign conditions, can be classified as evidence of blood in the urine of an individual.
Hematuria can be defined in two ways:
- Gross hematuria: When an individual can notice blood in his or her urine.
- Microscopic hematuria: When an individual cannot see the blood in urine on his or her own, but the presence of blood in urine can be noticed under a microscope.
The blood in urine may come from the kidneys that make urine. It may also come from other urinary tract parts such as the bladder (which stores urine), ureters (the tubes from the kidneys to the bladder), and urethra (the tube from the bladder to the outside of the body).
It is important to note that hematuria is described as a mortality predictor in patients with heart failure.
2. What are the causes of blood in urine?
The common causes of blood in urine or Hematuria are:
Benign
- Strictures
- Benign prostatic hypertrophy
- Renal masses (e.g. oncocytoma, angiomyolipoma)
Infective
- Pyelonephritis
- Urethritis
- Cystitis
Stones
- Uric acid stones
- Calcium stones
- Staghorn calculi
Trauma
- Renal injuries
- Pelvic trauma
- Foreign bodies
Latrogenic
- Traumatic catheterization
- Extracorporeal shockwave lithotripsy
- Radiation
- Indwelling ureteral stents
- Transrectal ultrasound (TRUS) guided prostate biopsy
- Renal biopsies
- Recent endoscopic procedure (e.g. transurethral resection of prostate [TURP])
Renal
- IgA nephropathy (Berger’s disease)
- Medullary sponge kidney
- Thin basement membrane diseases
- Hereditary nephritis
Malignant
- Renal cell carcinoma
- Prostate acinar adenocarcinoma
- Urothelial cell carcinoma
- Transitional cell carcinoma
- Squamous cell carcinoma
3. Who is at more risk of hematuria?
The risk factors for hematuria are:
- People who are more than 40 years old.
- History of gross haematuria.
- A history of smoking.
- Urinary Tract Infections (UTI).
- Inherited diseases such as cystic kidney disease and sickle cell anemia.
- An injury to the kidneys from sports or accident.
- Glomerulonephritis (inflammation in the filtering system).
- Exposure to occupational chemicals and dyes (e.g. heavy use of phenacetin, treatment with high cyclophosphamide doses, aristolochic acid).
- History of the irritative lower urinary tract or chronic cystitis symptoms (e.g. dysuria, nocturia, frequency, urgency, the sensation of incomplete emptying, and hesitancy).
- Inflammation of kidneys after a bacterial or viral infection (post-infectious glomerulonephritis).
- People with urinary stones or an enlarged prostate.
- Nonsteroidal anti-inflammatory pain relievers, cyclophosphamide, heparin, Aspirin, and antibiotics like penicillin can increase the risk of bleeding in the urine.
- Long-distance runners are prone to jogger’s hematuria or exercise-induced urinary bleeding. However, anyone performing strenuous exercise may experience this health condition.
4. Signs and Symptoms
People with hematuria may notice their urine color to be red, pink, tea-colored, or brownish-red. Some possible causes can have other signs such as:
- Bladder infections (acute cystitis): Bladder infections in adults generally result in pain or burning while urinating. Infants with infections of the bladder may be grumpy, feed poorly, and have a fever. Older children may experience burning and pain while urinating, have a fever, lower belly pain, or a strong urge to urinate.
- Kidney infections (pyelonephritis): Symptoms may include chills, fever, and lower back pain (flank).
- Kidney stones: Kidney stones may result in severe pelvic or belly pain.
- Kidney diseases: Symptoms include high blood pressure, body swelling, weakness, puffiness around the eyes.
- Kidney cancer: Individuals may experience loss of appetite, weight loss, pain in the side, or fatigue.
5. Tests and Diagnosis
The urologist will perform a physical examination and recommend blood tests to assess the level of blood loss or infection. Blood tests are also useful to evaluate renal function (including estimated glomerular filtration rate [eGFR] and creatinine) to make sure there is no renal function impairment. A prostate-specific antigen (PSA) test may also be recommended for male patients while a pelvic examination may be performed for female patients to identify the source of possible red blood cells in the urine.
Imaging tests may also be recommended by the urologist. X-ray tests of the kidneys, ureters, and bladder (XR-KUB) are effective to identify and monitor radiopaque renal and ureteric stones. The urologist may also recommend Computed tomography of the kidneys, ureters, and bladder (CT-KUB) that is considered to be the current gold standard to identify ureter and renal stones.
The urologist may recommend a CT scan to identify tumors, stones, or other problems in the kidneys, ureters, and bladder. A kidney ultrasound may be recommended for creating pictures of the kidneys. In some instances, the urologist may recommend cystoscopy, a procedure in which the urologist threads a small tube with a camera into the patient’s bladder through the urethra. The urologist may perform a biopsy to check for unusual or malignant cells.
6. How is it Treated?
A majority of hematuria episodes generally settle conservatively with no requirement for acute intervention. Some individuals with more significant hematuria (including hemodynamic instability, a high risk of clot retention, cardiovascular symptoms, or a drop in hemoglobin) will require admission to the hospital for continuous management of symptomatic anemia and bladder irrigation.
Hematuria’s most common emergency presentation is acute urinary retention and secondary clot retention (blood clots). This usually presents with an inability to urinate and acute abdominal pain. In such cases, patients will require continuous irrigation and catheter insertion or even blood transfusions. In extreme cases, the urologist may recommend emergency cystoscopy and diathermy if the patient is not responding to conservative management.
Take away
If you or someone you know is suffering from hematuria, please feel free to get in touch with Dr. Vikram Shah Batra, the best urologist in Delhi NCR, at The Urethra Clinic. A qualified and experienced Reconstructive Urologist, Neurologist, and Female Genitourinary Surgeon, Dr. Vikram is a leading Urology and Reconstructive Surgery Consultant at Sir Ganga Ram Hospital.
At Dr. Vikram’s Clinic, you will always be assured of the best treatment, a series of treatment options, and compassionate care. Schedule an appointment with urology experts at Dr. Vikram’s Clinic now!
