Hematuria is the medical term for the presence of blood in the urine. Hematuria may be visible to the eye (gross hematuria) or seen only under the microscope (microscopic hematuria). Either way, this signifies an abnormality. Blood may come from anywhere along the urinary tract, including: the kidneys, which make the urine; the ureter, the tube that carries urine to the bladder; the bladder, which stores the urine; the prostate (men only); or the urethra, the tube that carries urine out.
Causes
Hematuria has a number of potential causes, many of which are benign; however, it may be the only sign of a serious underlying medical condition, such as cancer. Causes include:
- "Idiopathic" - no cause found
- Urinary tract infection
- Stones (kidney, ureter, bladder)
- Benign Prostatic Hyperplasia (BPH) - enlarged prostate in men
- Trauma
- Jogger's hematuria - due to vigorous exercise, or sex
- Sexually transmitted diseases
- Tumors (kidney, ureter, bladder, prostate, urethra)
- Kidney diseases
- Medications (e.g., quinine, rifampin, phenytoin)
- Viral infection
Certain rare diseases and genetic disorders that also cause hematuria. Some of these are:
- Sickle cell anemia (inherited blood disorder)
- Systemic lupus erythmatosus (chronic inflammatory disorder of connective tissue)
Note: certain foods (i.e. rhubarb, beets, food coloring, certain medicines) can make the urine appear pink without actual blood being present; similarly, liver diseases can darken the urine, as can dehydration when the urine is very concentrated. None of these conditions are considered true “hematuria.”
Evaluation
You should notify your health care provider immediately if you see blood in your urine, even if you see it only one time. If hematuria is found incidentally without other symptoms, your doctor may send you for further evaluation. He or she will talk to you about the problem and possible associated symptoms and do a physical examination. Questions your doctor may ask include:
- Current pain (burning while urinating, difficulty urinating, pain in the back or sides)
- Smoking history (including prior smoking)
- Potential exposure to toxic substance dating back 25 years or more
- History of kidney stones
- Injuries and infections
- Recent and past drug use
- Recent illness
- Urinary habits
- Exercise habits
- Family history of kidney stones, sickle cell anemia, Von Hippel-Lindau disease
Further testing may include:
- "Dipstick" evaluation of the urine (using chemical reactions that might show abnormalities)
- "Microscopic evaluation" of the urine (directly viewing it under the microscope), which might show stone crystals, bacteria, abnormal cells, etc.
- Other tests of the urine, such as urinary cytology (looking at the shedded bladder cells)
- Cystoscopy (looking into the bladder with a videoscope)
- CT scan, ultrasound, Intravenous Pyelogram (IVP): special X-rays of the urinary tract
- Prostate Specific Antigen (PSA) test in men of appropriate age
Treatment
Your urologist will discuss the evaluation and findings with you to develop an appropriate plan. If no specific cause is found, the condition that caused hematuria may correct itself, or the hematuria may be “idiopathic” (no specific cause found); follow-up may still be necessary based upon risk factors and findings.