AUA Summit - What is Hematuria?

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What is Hematuria?

Hematuria is blood in the urine. When the urine is red or pink this could be linked to blood in the urine and is called “gross” or “visible” hematuria. Sometimes, blood is in the urine but is not seen by the naked eye and it is called “microscopic” hematuria since it can only be seen under a microscope.

During routine visits to your doctor, you are often asked to give a urine sample for testing. Blood might be found either using a chemical strip (called a dipstick) or under a microscope. If blood is detected in these ways, then you may have “microscopic hematuria."

Causes

There are many causes for blood in the urine. Most are not of worry, but some may call for care by your health care provider. Common causes for blood in the urine include:

  1. Urinary infection
  2. Enlarged prostate in older men
  3. Kidney or bladder stones
  4. Period in women
  5. Prostate infection
  6. Kidney disease
  7. Kidney trauma
  8. Bladder cancer
  9. Kidney cancer
  10. Cancer of the lining of the urinary tract
  11. Anti-swelling drugs (joint swelling and pain pills)
  12. Vigorous workout

When blood is found in the urine, doctors will want to make sure there is not a major health issue, such as a tumor in the kidney, urinary tract or bladder. Urologic cancers are rarely the cause of blood in the urine but can be life threatening.

Diagnosis

Your doctor will want to look for causes of the blood in your urine. This often involves an exam and learning your full health record to see if you have risks for cancer. The doctor will also be looking for non-cancer causes for blood in your urine, such as recent trauma, a urinary tract infection (UTI) or other procedures.

Your doctor will arrange any tests needed. If nothing is found to explain the blood in the urine, then your doctor may assess your level of risk for cancer as low, intermediate or high. These levels of risk are based on known risks for bladder cancer such as:

• Smoking history
• Age
• Gender
• Symptoms
• Number of red blood cells in the urine
• Certain types of chemotherapy
• Family history of bladder cancer, cancer of the urinary tract lining, or Lynch Syndrome
• Workplace exposures to chemicals such as benzene or aromatic amines
• Having a catheter in your urinary tract for long amounts of time

Testing

The goals of testing are two-fold. The first is to determine if there is an abnormality of the bladder and the second is to evaluate the upper urinary tract (kidneys, ureters which are the tubes that carry the urine to the bladder). A cystoscope is used to look at the bladder. This visual check of the bladder is done with a fiber optic camera. The upper urinary tracts are reviewed with imaging such as an ultrasound or CT scan. A urine cytology may also be performed. This is a test to look for suspicious cells in the urine. 

Doctors use guidelines about the risks to decide what kind of testing is needed for each person. A person at low risk may be able to avoid a lot of testing since their risk for cancer is low. A person at high risk needs a more in-depth testing.

Low Risk

Since patients at low risk rarely have cancer, doctors will likely discuss the benefits and drawbacks of more testing. A common option is to repeat a urine test within 6 months. If that test shows blood in the urine, then more testing is performed. If the repeat test does not show blood, then the patient is simply watched for symptoms. Additional testing may be required.

Intermediate Risk

Patients who are told they have an intermediate risk will be recommended to have a cystoscopy procedure to look at the bladder and a renal ultrasound to look at the kidneys. Additional testing may be required.

High Risk

Those who are at high risk often have a have test with a cystoscope to look at the bladder and a computed tomography (CT scan) of the abdomen and pelvis to look at the lining of the urinary tract. The main difference between a CT scan and ultrasound is that the CT scan can find small abnormalities in the kidney and ureters that may be missed by ultrasound.

Treatment

Most patients with blood in the urine do not have major problems. In fact, for many, a cause is not known. In those patients with a more serious condition, finding this early can be lifesaving. It is of great value to get tested and not ignore these findings especially if blood is seen in your urine.

Updated June 2023. 

Related Resources

Get the Facts about Hematuria


Hematuria: What Does Blood in the Urine Mean? with Dr. Ben Ristau

Hematuria is known as "Blood in the Urine" and it's a common issue in urology. We talked with Dr. Ben Ristau, a urologist with UConn Health, to learn more.


How Blood in the Urine is Tested and Treated

Hematuria is blood in the urine. Sometimes, blood is in the urine but is not easily seen and it is called “microscopic” hematuria since it can only be seen under a microscope.


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