Hematuria

Hematuria is the medical term for blood in the urine. It can be a symptom of a number of conditions, ranging from harmless to serious.

Types of hematuria

  • Microscopic hematuria: Blood is only visible under a microscope. It's often found during a routine exam or urine test.
  • Gross hematuria: Blood is visible to the naked eye, turning urine red or brown.

Symptoms

  • Painful or frequent urination
  • Urgent urination
  • Nausea or vomiting
  • Fever or chills
  • Pain in the lower abdomen or back

Causes

  • Bladder or kidney infections
  • Kidney or bladder stones
  • Enlarged prostate
  • Injury to the groin or genital area
  • Strenuous exercise
  • Certain medications, like blood thinners
  • Inherited conditions, like hemophilia or sickle cell disease
  • Tumors of the kidney, ureter, bladder, prostate or urethra

Tests

There are a number of tests available to determine the cause of hematuria. Most people do not need every single test.

  • Urine tests: Urine tests can provide clues about the cause of hematuria. This may include a urinalysis, which is performed with a dipstick test and sometimes uses a microscope to analyze the contents of the urine. Another test that may be performed is a urine cytology, which uses a microscope to analyze cells from the lining of the bladder and kidney (found in the urine).
  • Blood tests: Blood tests may be used to look for evidence of kidney or other diseases that can cause hematuria.
  • CT scan: Computed tomography, or CT scan, is a radiologic test that examines the structure of the kidneys, ureters, and bladder. Kidney stones or abnormalities of the kidneys, ureters, and bladder can usually be seen with a CT scan. A dye is usually injected into a vein during the test, which highlights any possible abnormalities.
  • Kidney ultrasound: An ultrasound of the kidney is an alternative to CT scan and is preferred for people who are allergic to the dye used in CT. Ultrasound uses sound waves to create a picture of the kidney's structure.
  • Cystoscopy: Cystoscopy is a procedure that is most often done in an office setting but sometimes is done as a day surgery procedure. A small tube with a camera is inserted into the bladder through the urethra (figure 1). A numbing gel is applied before the tube is inserted to decrease discomfort. The vast majority of patients tolerate this 5- to 10-minute procedure very well. During cystoscopy, the clinician examines the lining of the bladder to determine whether there are any abnormalities. If abnormal tissue is seen, a biopsy can be taken. The biopsy is examined with a microscope to determine whether abnormal or cancerous cells are present.

Treatment

Treatment depends on the underlying cause.