Blood in Urine

• Causes
• Tests 

Haematuria is the presence of red blood cells in the urine.

It can be divided into two categories:

1. Microscopic haematuria: red blood cells are only visible under a microscope.
2. Macroscopic haematuria: blood is visible in the urine, also known as ‘gross or frank haematuria’. This is always abnormal except in menstruating women and needs to be investigated.

Causes

There are many conditions that can cause haematuria, most of which are not-life-threatening. However there are a number of serious causes of haematuria, such as cancers, that need to be detected.

Common causes of haematuria include:

1. Urinary tract infection: Haematuria can be caused by an infection in any part of the urinary tract, most commonly the bladder (cystitis) or the kidney (pyelonephritis).
2. Inflammation/infection of the prostate in men.
3. Stones (calculi):
   • in the kidney,
   • bladder or connecting tubes.
4. Exercise: Exercise haematuria is a non-serious condition that athletes or joggers can get after intensive exercise.
5. Trauma: Traumatic injury to any part of the urinary tract from the kidneys to the urethral opening (the connection between the bladder and the outside world) can cause haematuria.
6. Drugs: Haematuria can be caused by medications, such as blood thinners, including heparin, warfarin or aspirin-type medications and cyclophosphamide (Cytoxan).
7. Glomerulonephritis: Glomerulonephritis refers to a group of kidney diseases that are characterized by inflammation of the glomeruli, the filtering units of the kidneys. Glomerulonephritis is a rare complication of certain viral and bacterial infections, but can also result from specific immune-system abnormalities, especially those involving immunoglobulin A (IgA), systemic lupus erythematosus (lupus or SLE) or diabetes. Sometimes there is no identifiable cause. 8) Bleeding disorders: including conditions that run in families such as haemophilia.
8. Cancers of the kidney, prostate or bladder.

Tests

Your doctor will usually perform some tests to look for the cause of the bleeding.

These include:

• Urinalysis: Firstly by dipstick testing in the surgery, then in the laboratory. Urine is analyzed in the laboratory under microscope to look for protein, white cells and red cells to identify a kidney or bladder infection, or kidney inflammation (Glomerulonephritis).
• Urine culture: urine is placed on culture plates to see if bacteria grow. This is used to confirm a urine infection that may be causing the haematuria.
• Cytology: used to detect cancer cells in the urine.
• Blood tests: to check for signs of urinary tract infection, kidney failure, anaemia (which often accompanies kidney problems), bleeding disorders, or abnormally high levels of blood chemicals that can encourage the formation of kidney stones.
• Radiology: a range of tests including intravenous pyelogram (the main test used), ultrasound of the urinary tract to look for abnormal masses such as stones, CT scanning.

Techniques to look directly into the urinary tract, such as cystoscopy or ureteroscopy. In these tests, a flexible telescope is placed into the urinary tract and passed into the bladder to inspect the bladder and connecting tubes for tumours or other problems. This test usually is done with local anaesthesia and sedation. Additional testing, such as renal biopsy (taking a sample of kidney tissue) may be necessary depending on the findings of the above tests. Treatment of haematuria depends the identified cause. For instance, if certain medications are causing the bleeding, these may need to be changed. Infections of the urinary tract are treated with the antibiotics. If a mass suspected of being a cancer is found anywhere in the urinary tract, referral to a urologist (urinary tract specialist) is necessary to guide further tests and treatment. In the case of a cancer being present, management is dependent on the type of cancer, location and how advanced it is (the stage), but the main types of treatments include surgery, radiotherapy, chemotherapy and hormonal therapy.

References