Hematuria

What Is It?

Hematuria is the presence of red blood cells in the urine. If there are enough red cells, the urine can become bright red, pink or cola colored. Often, however, the urine appears completely normal because there is not enough blood to cause a color change. In this case, the condition is called "microscopic" hematuria.

There are many possible causes of hematuria, including:

  • Urinary tract infection — Hematuria can be caused by an infection in any part of the urinary tract, most commonly the bladder (cystitis) or the kidney (pyelonephritis).

  • Kidney stones

  • Tumors in the kidney or bladder

  • Exercise — Exercise hematuria is a harmless condition that produces blood in the urine after strenuous exercise. It is more common in males than females.

  • 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 hematuria.

  • Drugs — Hematuria can be caused by medications, such as blood thinners, including heparin, warfarin (Coumadin) or aspirin-type medications, penicillins, sulfa-containing drugs and cyclophosphamide (Cytoxan).

  • Glomerulonephritis — Glomerulonephritis is a family of illnesses 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 (including strep throat). It can also occur in people with certain auto-immune diseases, systemic lupus erythematosus (lupus or SLE) and vasculitis. Sometimes there is no identifiable cause.

  • Bleeding disorders — These include the family of hemophilias.

Symptoms

By itself, hematuria rarely causes symptoms. One exception is when the bladder has so much blood in it that clots form, and the flow of urine is blocked. This can cause pain at the site of the blockage in the lower pelvis. Symptoms usually come from the cause of the hematuria, and vary depending on the condition:

  • Glomerulonephritis — If glomerulonephritis is not severe, it may not cause any symptoms. If symptoms appear, they can include swelling, especially in the lower extremities, reduced urination, and high blood pressure.

  • Kidney or bladder infection — Symptoms depend on the site of infection, but can include intense pain on one side of the mid-back, fever, shaking chills, nausea and vomiting, pain above the pubic or bladder region, foul-smelling urine, the need to urinate more often than normal, and pain or discomfort during urination.

  • Prostate infection — There can be pain in the lower back or in the area between the scrotum and anus, pain during ejaculation, blood in the semen, and, sometimes, fever and chills.

  • Tumor in the kidney or bladder —Most kidney and bladder cancers grow without causing any pain or discomfort. When symptoms develop, the most common are abdominal pain, more frequent urination and pain at the end of urination.

  • Kidney stones — When a kidney stone becomes trapped in one of the ureters (the narrow tubes connecting each kidney to the bladder), it can cause severe pain in the back, side or groin, nausea and vomiting, or painful and frequent urination.

  • Bleeding disorders — Bleeding disorders tend to cause abnormal bleeding throughout the body, not just into the urine. Depending on the specific bleeding problem, symptoms can include abnormal bruising, prolonged bleeding from cuts, bleeding in the skin, bleeding into the joints or gastrointestinal tract (causing black, tarry stools or bright red blood in the stool), or gum bleeding even with gentle flossing or brushing.

  • Trauma — There often will be signs of traumatic injury to the body surface, such as bruises, swelling, punctures and open wounds.

Diagnosis

Your health care professional will want a sample of your urine to confirm that you have hematuria. In women, blood can get into the urine during menstruation. Your doctor may want to repeat the urine test between periods.

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