Hematuria

Hematuria is the presence of blood in the urine, either visible or microscopic. It is a sign of bleeding from the kidneys, ureters, bladder, prostate, or urethra (the genitourinary system).

Many causes of hematuria are benign and only require observation. However, an evaluation may be recommended to rule out urologic cancer. Just 1% to 3% of patients evaluated for microscopic hematuria are diagnosed with urologic cancer, but the rate among patients with visible, or gross, hematuria is higher.

Hematuria will tint the color of urine from pink to dark brown and can include clots. It may also be intermittent, and not present itself consistently.

After a patient is diagnosed with hematuria, the physician may order additional studies or refer the patient to a urologist or nephrologist for further evaluation. Complete urologic evaluation includes:

• Urinalysis: A urine sample is examined for the presence of red blood cells. The physician may also send the urine to a lab to determine if bacteria are causing infection.
• Imaging of the kidneys:
  • A CT Scan or MRI: An imaging that screens for and determines the extent of disease.
  • Other tests may include:
    • Renal ultrasound: An imaging of the kidneys using a wand-like instrument that emits sound waves and picks up the echoes as they bounce off organs.
    • Intravenous urography or pyelogram (IVU or IVP): A series of x-rays using a contrast dye to highlight abnormalities
• Urinary cytologic evaluation: A urine specimen is collected and sent to a pathologist, who examines cells for cancer in the urinary tract.
• Cystoscopic examination: An examination of the urethra and bladder using a specialized telescope.

If the doctor does not find a serious source for the hematuria, the patient will likely require nothing more than close observation. If a more serious cause is detected, the patient will be referred to a specialist who will prescribe treatment.