What is hematuria?
Hematuria is when blood or red blood cells are present in your urine. There are two types of hematuria. It can be visible to the naked eye (gross hematuria) or only detectable under a microscope (microscopic hematuria).
How common is hematuria?
Hematuria is a relatively common issue affecting between 2.5% and 3% of the population, with microscopic hematuria being more prevalent.
While it can be alarming, hematuria doesn’t always indicate a serious problem. However, it is essential to investigate the cause because it can sometimes indicate an underlying condition that requires attention. For your peace of mind, if you notice blood in your urine, you should seek medical attention to rule out anything serious or life-threatening.
What are some common causes of hematuria?
Hematuria can originate from any part of the urinary tract, including the kidneys, ureters, bladder, urethra, and prostate. In women, it can also be mistaken for menstruation or bleeding from the vagina. Hematuria becomes more likely as we age, particularly in people over 50. Men over 50 are especially susceptible due to prostate-related conditions typical in older men.
Causes generally originate from diseases inside the kidneys (glomerular) or other parts of the urinary system (non-glomerular).
Hematuria caused by kidney disease
A nephrologist or kidney doctor will typically undertake a workup and management if the hematuria is related to internal kidney problems (glomerular). Examples of glomerular causes of hematuria include:
- Inflammation of the kidney’s filtering units (glomerulonephritis)—various factors, such as immune disorders or post-viral conditions, can cause this.
- Genetic conditions that can affect kidney function (e.g., Alport syndrome, thin basement membrane disease (TBMD)) or other systemic diseases (e.g., lupus).
We work closely with many excellent nephrologists at Tower Urology and will happily connect you with one of these specialists.
Non-kidney disease-related hematuria
If the hematuria is not caused by internal kidney disease, it may be caused by another area of the genitourinary tract. Urologists, particularly those at Tower Urology, are specialists in this kind of hematuria and have extensive experience in all the underlying causes.
Non-kidney-related causes of hematuria include:
- Infections: Infections can cause the lining of the urinary tract to bleed and include urinary tract infections (UTIs), bladder infections (cystitis), kidney infections (pyelonephritis), and sexually transmitted infections (STIs).
- Stones: Hard mineral deposits can form in the kidney (kidney stones) or bladder (bladder stones), irritating the urinary tract’s lining and causing small amounts of blood in the urine.
- Trauma: Any blunt or penetrating trauma can lead to bleeding from whichever area of the urinary tract is affected by the injury.
- Tumors: Benign or malignant growths in the kidneys, ureters, bladder, prostate, or urethra can spontaneously start bleeding.
- Prostate conditions: As the prostate enlarges with age (known as benign prostatic hyperplasia or enlarged prostate), it undergoes vascular changes and can bleed spontaneously or often when a catheter is inserted. Prostate cancer can also cause hematuria.
- Medications: Certain medications can cause hematuria, including anticoagulants, blood thinners, and chemotherapy.
- Other causes: These include radiation therapy to the pelvic area, which can often lead to bleeding from the bladder. Vigorous physical activity can also lead to bleeding from the urinary tract, particularly the kidneys. Furthermore, certain systemic diseases, such as sickle cell anemia and bleeding disorders, can also lead to hematuria.
What are the risk factors for hematuria?
Risk factors include:
- Older age (especially for cancer-related causes)
- Gender (men are at higher risk due to the prostate)
- Smoking (the number one risk factor for bladder cancer!)
- Family history of kidney disease or genitourinary cancers
- Use of blood-thinning medications
- Recurrent UTIs or STIs
- Strenuous exercise (especially for endurance athletes)
Being employed in certain industries can increase the risk of exposure to harmful chemicals that may impact the genitourinary system and cause hematuria. These include occupations in the rubber, dye, and textile industries, as well as the petroleum, plastic, and chemical industries. People employed as metalworkers, painters, printers, hairdressers, truck drivers, mechanics, railway workers, farmers, miners, dry cleaners, and leather tanners are also at an increased risk of hematuria.
How do we diagnose hematuria?
We take the following steps to diagnose:
- We will begin by taking a detailed history. This step will include asking you about symptoms such as pain during urination, flank pain, fever, or recent injuries, and then we will review any medications you are taking.
- We will ask about your family medical history to see if you might be at risk for genetic kidney diseases or bleeding disorders.
- We will perform a physical examination that will include feeling for abdominal masses, a possible prostate exam for men, and a pelvic exam for women.
- The first laboratory test we will order is a urinalysis. This will confirm the presence of blood in the urine sample and check for other clues, such as infection or abnormal cells.
- Then, depending on the findings, we may order further tests, including more detailed urine tests (such as urine culture, urine polymerase chain reaction (PCR) test, and cytology) or blood tests (to assess kidney function, blood clotting factors, etc.). Imaging tests may be considered, such as an ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), and/or a cystoscopy (a small camera used to examine the inside of the bladder). If we suspect a kidney problem, a kidney biopsy might be necessary.
How do we treat hematuria?
Deciding which hematuria treatment is proper depends entirely on the underlying cause. For example:
- If an infection is to blame, antibiotics will clear it up.
- If stones are the issue, we might recommend hydration, pain management, or procedures to remove the stones.
- If prostate issues are causing the bleeding, then we will recommend medications or procedural treatments.
- For more serious conditions like tumors, treatment might involve surgery, medications, or other specialized therapies like chemotherapy or radiation.
- If your medication is causing the hematuria, we will adjust or discontinue it.
In all cases, the goal is to address the primary condition while managing symptoms and preventing complications, such as anemia and clot retention. Therefore, promptly seeking treatment with us at Tower Urology is paramount.
How successful are Tower Urology’s hematuria treatments?
The good news is that many cases of hematuria are benign and will resolve with appropriate treatment.
However, because hematuria can sometimes indicate a more serious condition, it’s important not to ignore it. Early diagnosis and treatment are the best ways to ensure a positive outcome.
If you notice blood in your urine or have concerns, don’t hesitate to contact us at Tower Urology so our healthcare professionals can investigate further and provide the care you need, including all necessary follow-up care.
Tower Urology offers its patients the best hematuria care near you in Los Angeles
At Tower Urology, we take a personalized, evidence-based approach to urology care. All our professionals are committed to providing you with expert care. We take the time to understand you and personalize your treatment plan to your specific needs.
We invite you to establish a care plan with Tower Urology.
Tower Urology is conveniently located for patients throughout Southern California and the Los Angeles area, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Our services include treatment for incontinence, overactive bladder (OAB), UTIs, nocturia, kidney stones, and urinary bladder dysfunction.
Hematuria FAQs
Red flags for hematuria, or blood in the urine, include visible blood (gross hematuria), persistent microscopic hematuria, and systemic symptoms like fever, night sweats, or unexplained weight loss. These signs may indicate serious conditions such as kidney or bladder cancer, glomerular disorders, or infections.
Additional concerns include hematuria in individuals over 50 years of age, hypertension, edema, or a history of smoking and exposure to carcinogens. Painful urination, back pain, or blood clots in the urine are also warning signs that require immediate medical attention. Early evaluation is crucial to rule out life-threatening conditions and ensure timely treatment.
Hematuria, or blood in the urine, is not always harmless, as it can result from benign and serious conditions. Harmless causes include vigorous exercise, UTIs, kidney stones, or minor trauma to the urinary tract. However, hematuria can also signal serious health issues like kidney or bladder cancer, glomerular disease, or other underlying medical conditions.
Even if the blood is only visible under a microscope (microscopic hematuria), it should not be ignored. Consulting a healthcare provider is essential to identify the cause and ensure timely treatment, as early detection of serious conditions like cancer can significantly improve outcomes.
You should see a healthcare provider immediately if you notice blood in your urine, whether it appears pink, red, or brown, or if you see blood clots. Visible blood in the urine (gross hematuria) can indicate serious conditions like bladder or kidney cancer, infections, or kidney stones.
If the bleeding is accompanied by symptoms such as severe pain, fever, nausea, vomiting, or difficulty urinating, you should seek urgent care. Even microscopic hematuria—blood detectable only through lab tests—should be evaluated promptly to rule out underlying issues. Early diagnosis is crucial to establish the cause of the hematuria, prevent complications, and ensure effective treatment.
Dehydration is not a direct cause of hematuria, but it can contribute to conditions that lead to it. When your body lacks sufficient water, urine becomes concentrated, increasing the risk of kidney stones and UTIs.
Kidney stones can scratch or injure the urinary tract lining, while UTIs may irritate the bladder or urethra, both potentially causing blood in the urine. Severe dehydration and strenuous physical activity can also strain the kidneys, leading to hematuria. Staying hydrated is essential for preventing these complications and maintaining overall urinary health.
Stress does not directly cause hematuria but can indirectly contribute to conditions that may lead to it. Elevated stress levels increase cortisol (the stress hormone), which can weaken the immune system and make individuals more susceptible to infections like UTIs. UTIs, along with other conditions such as kidney stones, interstitial cystitis, or bladder inflammation, are common causes of hematuria.
Additionally, stress may exacerbate lower urinary tract dysfunctions like overactive bladder or urinary incontinence, creating a cycle of worsening symptoms and anxiety. If you notice blood in your urine, it is essential to consult a healthcare professional promptly to identify the underlying cause and receive appropriate treatment.
Sources
Hematuria (Blood in the Urine) in Children
https://www.kidney.org/atoz/content/hematuria
Hematuria (Blood in the Urine) In Adults
https://www.kidney.org/kidney-topics/hematuria-blood-urine-adults
Isolated Hematuria
https://www.merckmanuals.com/professional/genitourinary-disorders/symptoms-of-genitourinary-disorders/isolated-hematuria
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
http://www.niddk.nih.gov
