Definition & Overview

Hematuria is a medical condition characterized by the presence of blood in the urine. The condition is classified as either gross hematuria (the presence of either light pink or dark coloured blood with clotting) or microscopic hematuria, which can only be detected under a microscope or when the urine is tested.

While gross hematuria is easily detected as most patients seek medical attention following the presence of the abnormal urine colour, those who have microscopic hematuria are mostly not aware of their condition until it is detected during a regular checkup or when diagnosing other complaints.

Hematuria is mostly a symptom of an underlying medical condition. Thus, the treatment for this condition will likely to coincide with the treatment of the underlying causes. When diagnosing the cause or causes of hematuria, the entire urinary tract is thoroughly assessed to rule out one possible cause after the other until an accurate diagnosis can be made.

In most cases, the underlying cause of hematuria is benign. However, more serious conditions can also be the cause of hematuria. Cause of Condition

Hematuria can be caused by a wide variety of factors. Some of the most common are:

Although the condition can affect people of any age, it is more prominent among those who are over the age of 50, have urinary stone disease, had a recent viral or bacterial infection, have an enlarged prostate, have a family history of a kidney disease, or taking certain types of medications.

If you notice blood in your urine, you should see a doctor as soon as possible to have it diagnosed. Some people may experience other symptoms and some may be asymptomatic. Regardless of whether or not other symptoms are present, seeing a doctor will ensure that the exact cause or causes are identified and that the condition is properly treated.

Key Symptoms

Hematuria is in itself a symptom of an underlying medical condition, but other symptoms may also be present and could be moderate or severe, depending on the primary cause of the condition.

  • If hematuria is caused by a kidney infection, the other symptoms may include fever, flank pain, or lower back pain.
  • If kidney stones are causing hematuria, the patient will normally display symptoms such as severe abdominal or pelvic pain.
  • If the patient has a bladder infection, the usual symptoms are a burning sensation while urinating, fever, lower belly pain, and irritability.

In some cases, hematuria may not be accompanied by other symptoms. For this reason, microscopic hematuria is typically only discovered while undergoing a routine check-up or when getting treatment for other but related medical conditions.

Who to See & Types of Treatment Available

If you notice blood in your urine, the first medical professional to see is your family doctor who will review your family's history of diseases and carry out a physical examination. Physical exams will likely include the following:

  • Examination of the genitalia
  • Skin examinations
  • Blood pressure measurement
  • Ophthalmologic evaluation
  • Abdominal examination

The doctor will then determine if you have glomerular or non-glomerular hematuria. Glomerular hematuria is usually described as the presence of blood in the urine that is brown in colour while non-glomerular hematuria has reddish or pink colour and blood clots are present.

After the physical examination, your doctor will require laboratory tests, such as:

  • Urinalysis to review the urine sample
  • Blood urea nitrogen (BUN)
  • Serum creatinine
  • Hematologic and coagulation studies
  • Urine culture
  • Serologic testing
  • Urine calcium excretion

You may also be asked to undergo imaging tests, such as:

  • Spiral CT
  • Radionuclide studies
  • Renal and bladder ultrasonography
  • Voiding cystourethrography

All the above tests and procedures are performed one at a time to rule out one possible cause after the other until the doctor can come up with an accurate diagnosis.

After pinpointing the cause of hematuria, the doctor will present treatment options for the condition. Because of a wide variety of causes, the treatment options are numerous. In most cases, treatment for the condition will only involve medications. However, more serious cases like kidney stones or cancer may require surgical procedures as well.

The success of a certain treatment does not necessarily provide a guarantee that the condition will not recur in the future. In fact, if you don’t take preventive actions, there is a good chance that you’ll experience hematuria with a different or similar cause.

It is best to discuss with your doctor the best ways to prevent hematuria. One of the most likely preventive measures is making changes in your lifestyle. Eating a more healthy diet, avoiding overly strenuous exercises, and undergoing regular checkups will significantly lower your risk of suffering from the same condition again.

References:

  • Gerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 3.
  • Landry Dw, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116.
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