Haematuria is the occurrence of blood in urine and can be either visible or microscopic (blood cells only visible through a microscope). Gross or visible haematuria can vary in appearance, from being light pink to deep red with clots.
The same types of conditions cause haematuria, however, the amount of blood in the urine may be different. The same kind of workup or evaluation is required for treating haematuria. Gross haematuria is the primary problem with which people visit their doctors. On the other hand, microscopic haematuria is most commonly detected as a part of a periodic check-up by a primary-care physician.
Similar causes are responsible for gross and microscopic haematuria. They may result from bleeding anywhere along the urinary tract. Microscopic haematuria is a common result of urinary tract infections (UTIs).
One cannot readily distinguish between blood originating in the kidneys, ureters (the tubes that transport urine from the kidneys to the bladder), bladder, or urethra. Any degree of blood in the urine should be fully evaluated by a physician, even if it resolves spontaneously.
Normally, urine is naturally sterile and should not contain bacteria. Kidney and bladder stones can cause irritation and abrasion of the urinary tract, which can lead to microscopic or gross haematuria. If a trauma affects any of the components of urinary tract or the prostate, it can lead to bloody urine.
Renal diseases, as well as haematologic disorders involving the body’s clotting system can also be linked with haematuria. Medications that increase the risk of bleeding, such as aspirin, warfarin, or clopidogrel, may also lead to bloody urine. Lastly, cancer anywhere along the urinary tract can present with haematuria.
Patients, who experience visible haematuria, get prompted to seek medical attention; however, microscopic haematuria can be just as severe. Because it has no symptoms and the patient cannot notice blood in the urine, it can be detected through urine dipstick test (a basic diagnostic tool used to determine pathological changes in a patient’s urine in standard urinalysis). If three or more red blood cells (RBC) are seen per high power field on two of three specimens, further evaluation to determine a cause is recommended.
Any patient with gross haematuria or significant microscopic haematuria should have further evaluation of the urinary tract. The first step is a careful history and physical examination. Laboratory analysis consists of a urinalysis and examination of urinary deposit under a microscope. The urine should be evaluated for protein (a sign of kidney disease) and evidence of urinary tract infection. The number of red blood cells per high-powered field should be checked. In addition the shape of the blood cells should be measured.
A complete urologic evaluation for haematuria also includes X-rays of the kidneys and ureters to detect kidney masses, tumours of the ureters and the presence of urinary stones. This traditionally consisted of an intravenous pyelogram (IVP).
Many physicians may opt for other imaging studies such as a computerized tomography (CT) scan. This is the favoured method of assessing kidney masses and is the best mode for measuring urinary stones. Recently many urologists have started using CT urography. This allows the urologist to look at the kidneys and ureters with one X-ray test.
A blood test to check kidney function and a blood-pressure check should also be done. Men over 50 should discuss with their doctor an annual prostate-specific antigen (PSA) blood test which is used to screen for prostate cancer.
In at least eight ,to ten percent of cases, no cause of haematuria is found. According to some studies, an even higher percentage of patients have no cause. Unfortunately, studies have shown that urologic malignancy is later discovered in one to three percent of patients with negative results.
Treatments for haematuria change widely and depend on the reason for the bleeding. It is important to know that often, no cause is found for haematuria. This should not be a source of major concern, however, since appropriate test results effectively rule out the most serious causes of haematuria, such as cancer.
In cases where the test results are negative and the cause of the haematuria stays unknown, observation with repeat urinalyses is the sensible choice.
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