Haematuria (blood in urine)
Haematuria is a common condition which must be taken seriously. It may be a symptom of an underlying disease, some of which are life threatening or can be treated. So if you notice blood in your urine, it should always be investigated, although in most cases, no serious cause will be found. In many such patients, particularly young adult patients, the haematuria is transient and of no consequence . On the other hand, there is an appreciable risk of malignancy (cancer) in older patients (eg, age above 40), even if transient. However, even among older patients, an urologic cause cannot often be identified.
Liquid waste leaves your body as urine through the urinary tract. The urinary tract includes the kidneys and ureters (upper urinary tract), and the bladder and urethra (lower urinary tract). Urine is typically yellow in colour, but can have a different colour for many reasons. Blood can make the urine look red, pinkish or dark.
Blood in urine can be characterised as either “gross” (visible to the naked eye) or “microscopic” (visible only under a microscope). The color change does not necessarily reflect the degree of blood loss since as little as 1 ml of blood per liter of urine can induce a visible color change. Further clinically relevant distinctions can be made between painful and painless haematuria, and haematuria of glomerular and post-glomerular origin.
Below is a summary of the main causes of blood in urine:
- Bladder infection, as well as and sexually transmitted diseases (particularly in women), which often also causes burning or pain when one urinates
- Kidney infection, which often also causes back pain and fever
- Schistosomiasis (bilharzia), the urinary form is associated with increased risks for bladder cancer in adults (this disease is found commonly in tropical countries in Africa, Asia and South America)
- Kidney stones
- Sickle cell disease
- Certain kidney diseases
- certain medications (e.g., anticoagulant drugs such as aspirin, ibuprofen, heparin or coumadin)
- Food (for example eating a lot of beets or food dyes)
- Intense exercise or trauma (for example, if you fall off a bike and bruise a kidney)
- Enlargement of the prostate (called “benign prostatic hyperplasia”), which is common in older men
- Cancer of the kidney, ureter, bladder and prostate
- Benign kidney tumor (noncancerous)
The initial step in the evaluation of patients with red urine is centrifugation of the specimen to see if the red or brown colour is in the urine sediment or the supernatant. If white blood cells are found in addition to red blood cells, then it is a signal of urinary tract infection, which can be treated with antibiotics. As contamination with blood is a possibility in menstruating and post-partum women, urine for analysis is best obtained when the other cause of bleeding has ceased. If this is not possible, a tampon can be inserted, and urinalysis obtained after the perineum is thoroughly cleansed.
Kidney (renal or glomerular) disease is a common benign (non-cancerous) cause of hematuria, which can lead to kidney failure in some patients. Abnormal findings in these patients often include unusually high protein levels and “casts” (groups of cells clustered together in the urine and visible under the microscope).
The evaluation of blood in urine should include a complete medical history, physical examination and microscopic urinalysis. Once the nature of the haematuria and any accompanying symptoms are established, further evaluation may consist of a cystoscopy (a lighted telescope placed into the bladder) for direct internal examination, appropriate X-ray studies, intravenous urography, retrograde pyelography and ureteroscopy, ultrasonography and CT-scan.
In some cases the urine should be evaluated for the presence of any abnormal cells suggestive of malignancy/cancer (this is called urinary cytology). Such cells may come from the lining of the bladder, urethra or upper urinary tract. If any abnormal cells are found, further testing should be done.
Most of the interest in painless haematuria stems from the desire to diagnose bladder tumours at an early stage. Blood in urine of any degree should never be ignored and, in adults, should be regarded as a symptom of urologic malignancy or cancer until proven otherwise and demands immediate urological examination by medical experts, especially urologists.
Amissah Samuel, MD
Clinic (Hospital) Combine Southwest
Dept. of Urology
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