Hematuria

Hematuria is blood in the urine and can be present for several reasons. It could be an indication of a serious condition or it may be normal for certain people.

Studies have shown that between nine and 18 percent of normal individuals can have some degree of hematuria. However, hematuria can be a sign of an important medical condition requiring treatment. Below is a list of common causes of hematuria:

Bladder Cancer
Kidney Cancer
Prostate Cancer
Ureteral Cancer
Urinary Stone Disease
Urinary Tract Infection
Pyelonephritis (Kidney Infection)
Benign Prostatic Hypertrophy (Enlarged Prostate)
Renal (Kidney) Disease
Radiation or Chemical Induced Cystitis (Bladder Irritation)
Injury to the Urinary Tract
Prostatitis (Prostate Infection)
Exercise Hematuria

When a person sees blood in their urine they should contact their physician. This is called visible or “gross” hematuria. Microscopic hematuria can be detected by a simple urine analysis. The physician determines the amount of blood by looking at the urine with a microscope. If three or more red blood cells are seen per high power field on two of three specimens, further evaluation to determine a cause is required.

Any person with gross hematuria or significant microscopic hematuria should have further evaluation of the urinary tract. Typically this will include some form of radiologic imaging of the kidneys, a cystoscopy to visualize the bladder lining and simple blood and urine tests. The first step is a careful history and physical examination including a urinalysis and examination of urinary sediment under a microscope. The urine should be evaluated for protein to rule out kidney disease and urinary tract infection. Sometimes a urine culture is performed. A urine cytology is obtained to look for abnormal cells in the urine. Blood work should be done to measure serum creatinine (a measure of kidney function). Those patients with significant protein in their urine, abnormally shaped red blood cells, or an elevated creatinine level should undergo further medical evaluation for the presence of kidney disease.

Additionally, the good news is in about 10 percent of cases, no cause for hematuria is found. However, studies have shown that urologic malignancy is later discovered in one to three percent of patients with negative work-ups. Therefore, some form of routine follow-up is recommended.