Hematuria

Hematuria is blood in the urine.

Two types of blood in the urine exist. Blood that can be seen in the urine is called gross hematuria. Blood that cannot be seen in the urine, except when examined with a microscope, is called microscopic hematuria.

Almost anyone, including children and teens, can have hematuria.

Factors that increase the chance a person will have hematuria include

  • a family history of kidney disease
  • an enlarged prostate, which typically occurs in men age 50 or older
  • urinary stone disease
  • certain medications including aspirin and other pain relievers, blood thinners, and antibiotics
  • strenuous exercise such as long-distance running
  • a recent bacterial or viral infection

 

Hematuria can be caused by menstruation, vigorous exercise, sexual activity, viral illness, trauma, or infection, such as a urinary tract infection (UTI).

More serious causes of hematuria include

  • cancer of the kidney or bladder
  • inflammation of the kidney, urethra, bladder, or prostate
  • polycystic kidney disease: an inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time, taking over and destroying working kidney tissue
  • blood clots
  • blood clotting disorders, such as hemophilia
  • sickle cell disease: an inherited disorder in which RBCs form an abnormal crescent shape, resulting in less oxygen delivered to the body’s tissues, clogging of small blood vessels, and disruption of healthy blood flow

 

Most people with microscopic hematuria do not have symptoms.

People with gross hematuria have urine that is pink, red, or cola-colored due to the presence of red blood cells (RBCs). Even a small amount of blood in the urine can cause urine to change color. In most cases, people with gross hematuria do not have other symptoms. However, people with gross hematuria that includes blood clots in the urine may have pain.

Hematuria is diagnosed with urinalysis, which is testing of a urine sample. 

The health care provider will take a thorough medical history. The health care provider may order one or more of the following tests:

  • Urinalysis. Further testing of the urine may be done to check for problems that can cause hematuria, such as infection, kidney disease, and cancer. 
  • Blood test. A blood test involves drawing blood at a health care provider’s office or commercial facility and sending the sample to a lab for analysis. A blood test can show the presence of high levels of creatinine, a waste product of normal muscle breakdown, which may indicate kidney disease.
  • Biopsy. A biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. The biopsyis performed by a health care provider in a hospital with light sedation and local anesthetic.The test helps diagnose the type of kidney disease causing hematuria.
  • Cystoscopy. Cystoscopy is a procedure that uses a tubelike instrument to look inside the urethra and bladder. Cystoscopy may be used to look for cancer cells in the bladder, particularly if cancer cells are found with urinalysis. 
  • Kidney imaging tests. Intravenous pyelogram (IVP) is an x ray of the urinary tract.  When a small mass is found with IVP, another imaging test, such as an ultrasound, CT scan, or magnetic resonance imaging (MRI), can be used to further study the mass. Imaging tests may show a tumor, a kidney or bladder stone, an enlarged prostate, or other blockage of the normal flow of urine.

 

Hematuria is treated by treating its underlying cause. If no serious condition is causing hematuria, no treatment is needed. Hematuria caused by a UTI is treated with antibiotics; urinalysis should be repeated 6 weeks after antibiotic treatment ends to be sure the infection has resolved.