Hematuria (Blood in the Urine)

What is hematuria?
Hematuria is the presence of red blood cells (RBCs) in the urine. In microscopic
hematuria, the urine appears normal to the naked eye, but examination with a
microscope shows a high number of RBCs. Gross hematuria can be seen with the
naked eyethe urine is red or the color of cola.
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What causes hematuria?

Several conditions can cause hematuria, most of them not serious. For example,
exercise may cause hematuria that goes away in 24 hours. Many people have
hematuria without any other related problems. Often no specific cause can be found.
But because hematuria may be the result of a tumor or other serious problem, a doctor
should be consulted.
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How is hematuria diagnosed?

To find the cause of hematuria, or to rule out certain causes, the doctor may order a
series of tests, including urinalysis, blood tests, kidney imaging studies, and cystoscopic
examination.

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Urinalysis is the examination of urine for various cells and chemicals. In addition
to finding RBCs, the doctor may find white blood cells that signal a urinary tract
infection or casts, which are groups of cells molded together in the shape of the
kidneys' tiny filtering tubes, that signal kidney disease. Excessive protein in the
urine also signals kidney disease.
Blood tests may reveal kidney disease if the blood contains high levels of wastes
that the kidneys are supposed to remove.
Kidney imaging studies include ultrasound, computerized tomography (CT) scan,
or intravenous pyelogram (IVP). An IVP is an x ray of the urinary tract. Imaging
studies may reveal a tumor, a kidney or bladder stone, an enlarged prostate, or
other blockage to the normal flow of urine.
A cystoscope can be used to take pictures of the inside of the bladder. It has a
tiny camera at the end of a thin tube, which is inserted through the urethra. A
cystoscope may provide a better view of a tumor or bladder stone than can be
seen in an IVP.

How is hematuria treated?

Treatment for hematuria depends on the cause. If no serious condition is causing the
hematuria, no treatment is necessary.
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What is blood in urine (hematuria)?

Hematuria, or blood in the urine, can be either gross (visible) or microscopic (as
defined by more than three to five red blood cells per high power field when
viewed under magnification). Gross hematuria can vary widely in appearance,
from light pink to deep red with clots. Despite the quantity of blood in the urine
being different, the types of conditions that can cause the problem are the same,
and the workup or evaluation that is needed is identical.
People with gross hematuria usually present to their doctor with this as a primary
complaint. Microscopic hematuria, on the other hand, is most commonly detected
as part of a periodic checkup by a primary-care physician.

What are the causes of blood in urine?

The causes of gross and microscopic hematuria are similar and may result from
bleeding anywhere along the urinary tract. One cannot readily distinguish
between blood originating in the kidneys, ureters (the tubes that transport urine
from the kidneys to the bladder), bladder, or urethra. Any degree of blood in the
urine should be fully evaluated by a physician, even if it resolves spontaneously.
Infection of the urine, stemming either from the kidneys or bladder, is a common
cause of microscopic hematuria. Kidney and bladder stones can cause irritation
and abrasion of the urinary tract, leading to microscopic or gross hematuria.
Trauma affecting any of the components of the urinary tract or the prostate can
lead to bloody urine. Hematuria can also be associated with renal (or kidney)
disease, as well as hematologic disorders involving the body's clotting system.
Medications that increase the risk of bleeding, such

as aspirin, warfarin (Coumadin), orclopidogrel (Plavix), may also lead to bloody

urine. Lastly, cancer anywhere along the urinary tract can present with hematuria.

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Blood In Urine Index
Glossary

Blood In Urine (cont.)

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In this Article

What is blood in urine (hematuria)?

What are the causes of blood in urine?

How is blood in urine diagnosed?

How is blood in urine treated?

Blood in Urine (Hematuria) At A Glance

Blood In Urine Glossary

Blood In Urine Index

How is blood in urine diagnosed?

The evaluation for blood in urine consists of taking a history, performing a physical examinatio
microscope, and obtaining a culture of the urine. Lower urinary tract symptoms, such as urgen
and frequency (needing to urinate frequently), as well as the presence offever and/or chills are
trauma, even if believed by the patient to have been inconsequential, should be considered as
and/or flank pain, especially if radiating to the inguinal or the genital area, may suggest kidney
including vitamins or herbal supplements, should be reviewed with the health-care provider. H
even if the patient has been taking a medication that is associated with bleeding, a full workup
undertaken.

The physical exam will focus on possible sources of hematuria. Bruising over the back or abd
rectal exam should be performed, as findings consistent with prostatitis (for example, tenderne
an enlarged prostate (suggestive of BPH or benign enlargement of the prostate gland) may be

repeat urinalysis, as well as a urine culture, should be obtained. The presence of white blood
consistent with a urinary tract infection. Protein, glucose, or sediment in the urine may indicate
kidneys. Blood tests are also important, as they will aid in assessing renal function and identif

In addition to the basic history and physical exam, there are three additional components for a
urine cytology, andcystoscopy.

The CT scan is an imaging evaluation of the urinary tract. Prior to the procedure, the patient d
dye is injected intravenously. The patient then goes through the CT scan machine and images
pelvis. Another test that can be performed, the intravenous pyelogram(IVP), is also a type of X
In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A seri
30-minute period to look for abnormalities. The CT scan is more commonly performed than th
and should be considered the test of choice. Both of these studies are especially useful for ev
not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is n
minute procedure wherein a thin, flexible cystoscope (or fiberoptic camera) is inserted via the
directly visualize any lesions or sources of bleeding. This is usually done with local anesthetic
Finally, urine cytology involves giving a urine sample to be analyzed by a pathologist for the p
appearing cells.

Next: How is blood in urine treated?

Blood in Urine (Hematuria) At A Glance

Blood in urine can sometimes be visible only with a microscope.

Evaluating blood in urine requires consideration of the entire urinary tract.
Tests used for the diagnosis of blood in urine include a CT scan, cystoscopy,
and urine cytology.
Management of blood in the urine depends upon the underlying cause.

Hematuria Treatment
Treatment for Hematuria
Treatment ranges from antibiotic therapy to surgery, depending on the underlying
cause.
Questions to Ask Your Doctor about Hematuria
(Free Handout)

Benign prostatic hyperplasia (BPH) may be treated many ways. Eliminating foods
and beverages from the diet and over-the-counter medications that irritate the prostate
and cause it to swell is one option. Medication (e.g., terazosin) is often prescribed to
treat BPH. When the condition does not respond to these measures, surgical removal of
all or part of the gland may be recommended.
Kidney and bladder stones typically require procedures that remove or break up the
stones, as well as measures to prevent their recurrence.
Kidney disease is treated according to diagnosis. In severe cases, dialysis may be
necessary.
Medications (e.g., quinine, rifampin, phenytoin) that cause hematuria are discontinued.
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Trauma-induced hematuria (e.g., a blow to the kidneys) is treated according to the

severity of the injury, ranging from bed rest and close clinical observation to surgical
repair or, in extreme cases, removal of the damaged tissue or organ.
Cancerous tumors found in the kidney, ureters, prostate, or bladder may be treated
with radiotherapy, chemotherapy, and surgery.
Urinary tract blockages are treated with correction or removal of the blockage.
Viral infections of the urinary tract and sexually transmitted diseases (STDs),
particularly in women, are treated with medication.
Hematuria Prognosis
Prognosis differs according to the underlying condition and the patient's response to
treatmen
z