There is a presence of red blood cells (erythrocytes) sometimes in the urine. This condition is called Hematuria, or Haematuria. The status of it may be idiopathic and/or benign, or it may indicate that there is a kidney stone or a tumour in the urinary tract (kidneys, ureters, urinary bladder, prostate, and urethra), that ranges from trivial to lethal. Urinary tract infection may occur if white blood cells are found in addition to red blood cells.
Sometimes, the term “hemoglobinuria” is also used, although more precisely it refers only to hemoglobin in the urine.
Consult a urology doctor for proper treatment if you have Hematuria.
Causes:
Hematuria is caused by many factors. The most common of them are:
- Cancer of the kidney, prostate or bladder
- Urinary tract infection with bacteria. Escherichia coli may be the cause of the vast majority of UTIs, with Klebsiella pneumonia and Staphylococcus saprophyticus causing a smaller percentage
- Trauma
- Nephrolithiasis: stones in the kidney, bladder or ureter
- Polycystic kidney disease
- Indwelling urinary catheter
- Benign prostatic hyperplasia, mostly in men above 50
- Vigorous exercise
- No cause found
There are also other less common causes of hematuria. They include:
- A major cause for hematuria in many African and Middle-Eastern countries is Schistosomiasis (caused by Schistosoma haematobium)
- Glomerular bleeding: e.g.: Alport syndrome, thin basement membrane disease, IgA nephropathy (“Berger’s disease”),
- Urethritis
- Sickle cell disease
- Recent instrumentation of the urinary tract
- Kidney diseases
- Prostatitis
- Arteriovenous malformation of the kidney (may impress like renal cell carcinoma on scans as both are highly vascular, though it is in the rare case)
There are some rare cases. A brief description of them is given below.
- Due to obstruction of the inferior vena cava, vesical varices may rarely develop
- A rare disease called paroxysmal nocturnal hemoglobinuria where hemoglobin of hemolyzed cells is passed into the urine
- Malignant hypertension causing Fibrinoid necrosis of the Glomeruli
- A rare vascular abnormality responsible for gross hematuria is left renal vein hypertension, also called “nutcracker phenomenon” or “nutcracker syndrome,”
- The allergy may rarely cause episodic gross hematuria in children
- March hematuria secondary to repetitive impacts on usually the feet and also the body
- Ureteral Pelvic Junction Obstruction (UPJ) is a rare condition beginning from birth in which the ureter is blocked between the kidney and bladder. This condition may cause blood in the urine
- Athletic nephritis secondary to strenuous exercise
- Alport syndrome
Hematuria has resemblance with some other signs. They include:
- Consumption of beets (“beeturia”)
- Medications can cause red discolouration of the urine, but not hematuria. Some examples include: sulfonamides, quinine, rifampin, phenytoin
- Menstruation
Diagnosis
A good urologist can do a proper diagnosis of the disease.
The medical history and urine testing, or urinalysis, sometimes help to elucidate the cause of hematuria. This is especially true for young people, in whom the risk of malignancy is very low. For example, a young woman only needs antibiotics for her UTI and does not need a further workup for her hematuria, if she is found to have hematuria along with a simple urinary tract infection. Hematuria can also be caused by high-intensity exercise. As such, an athlete will be asked to go for a repeat urine test, if there is blood in the urine after vigorous exercise.
CT scanning or Ultrasound is often suggested at first for patients with suspected kidney stones, a common cause of hematuria. Further imaging is usually done for most other patients with continued, unexplained hematuria, because of the risk of cancer of the bladder, prostate, ureters, or kidney is a concern. This includes directly looking at the urethra and bladder with cystoscopy and more sensitive radiographic imaging with computed tomography urography.
Loin pain hematuria syndrome is a rare but possible cause if combined with flank pain.
