Hematuria: Blood in the Urine National Kidney and Urologic Diseases Information Clearinghouse What is hematuria? Hematuria is blood in the urine. Two types of blood in the urine exist. Blood that can be seen in the urine is called gross hematu- U.S. Department of Health and ria. Blood that cannot be seen in the urine, Human Services except when examined with a microscope, is called microscopic hematuria. NATIONAL INSTITUTES OF HEALTH What are the symptoms of Kidneys hematuria? Most people with microscopic hematuria do not have symptoms. People with gross hematuria have urine that is pink, red, or cola-colored due to the presence of red blood cells (RBCs). Even a small amount of Bladder blood in the urine can cause urine to change Ureters color. In most cases, people with gross hematuria do not have other symptoms. However, people with gross hematuria that Urethra includes blood clots in the urine may have pain. The urinary tract What is the urinary tract? the two kidneys process about 200 quarts The urinary tract is the body’s drainage of blood to produce about 1 to 2 quarts of system for removing wastes and extra water. urine, composed of wastes and extra water. The urinary tract includes two kidneys, two The urine flows from the kidneys to the ureters, a bladder, and a urethra. The kid- bladder through tubes called ureters. The neys are two bean-shaped organs, each about bladder stores urine until releasing it through the size of a fist. They are located near the urination. When the bladder empties, urine middle of the back, just below the rib cage, flows out of the body through a tube called one on each side of the spine. Every day, the urethra at the bottom of the bladder. What causes hematuria? Who is at risk for Hematuria can be caused by menstruation, hematuria? vigorous exercise, sexual activity, viral illness, Almost anyone, including children and teens, trauma, or infection, such as a urinary tract can have hematuria. Factors that increase infection (UTI). More serious causes of the chance a person will have hematuria hematuria include include • cancer of the kidney or bladder • a family history of kidney disease • inflammation of the kidney, urethra, • an enlarged prostate, which typically bladder, or prostate—a walnut-shaped occurs in men age 50 or older gland in men that surrounds the urethra at the neck of the bladder and supplies • urinary stone disease fluid that goes into semen • certain medications including aspirin • polycystic kidney disease—an inherited and other pain relievers, blood thinners, disorder characterized by many grape- and antibiotics like clusters of fluid-filled cysts that • strenuous exercise such as long-distance make both kidneys larger over time, tak- running ing over and destroying working kidney tissue • a recent bacterial or viral infection • blood clots How is hematuria • blood clotting disorders, such as diagnosed? hemophilia Hematuria is diagnosed with urinalysis, • sickle cell disease—an inherited disor- which is testing of a urine sample. The urine der in which RBCs form an abnormal sample is collected in a special container in crescent shape, resulting in less oxygen a health care provider’s office or commercial delivered to the body’s tissues, clogging facility and can be tested in the same loca- of small blood vessels, and disruption of tion or sent to a lab for analysis. For the test, healthy blood flow a nurse or technician places a strip of chemi- cally treated paper, called a dipstick, into the urine. Patches on the dipstick change color when RBCs are present in urine. When blood is visible in the urine or a dipstick test of the urine indicates the presence of RBCs, a health care provider examines the urine with a microscope to make an initial diagno- sis of hematuria. The next step is to diag- nose the cause of the hematuria. 2 Hematuria: Blood in the Urine The health care provider will take a thorough • Cystoscopy. Cystoscopy is a procedure medical history. If the history suggests a that uses a tubelike instrument to look cause that does not require treatment, the inside the urethra and bladder. Cys- urine should be tested again after 48 hours toscopy is performed by a health care for the presence of RBCs. If two of three provider in the office, an outpatient urine samples show too many RBCs when facility, or a hospital with local anes- viewed with a microscope, more serious thesia. However, in some cases, seda- causes should be explored. The health care tion and regional or general anesthesia provider may order one or more of the fol- are needed. Cystoscopy may be used lowing tests: to look for cancer cells in the bladder, particularly if cancer cells are found • Urinalysis. Further testing of the urine with urinalysis. For more informa- may be done to check for problems that tion about cystoscopy, see the National can cause hematuria, such as infection, Kidney and Urologic Diseases Informa- kidney disease, and cancer. The pres- tion Clearinghouse (NKUDIC) fact ence of white blood cells signals a UTI. sheet Cystoscopy and Ureteroscopy at RBCs that are misshapen or clumped www.urologic.niddk.nih.gov. together to form little tubes, called casts, may indicate kidney disease. • Kidney imaging tests. Intravenous Large amounts of protein in the urine, pyelogram (IVP) is an x ray of the uri- called proteinuria, may also indicate nary tract. A special dye, called contrast kidney disease. The urine can also be medium, is injected into a vein in the tested for the presence of cancer cells. person’s arm, travels through the body to the kidneys, and makes urine vis- • Blood test. A blood test involves draw- ible on the x ray. The contrast medium ing blood at a health care provider’s also shows any blockage in the urinary office or commercial facility and send- tract. When a small mass is found ing the sample to a lab for analysis. A with IVP, another imaging test, such as blood test can show the presence of high an ultrasound, CT scan, or magnetic levels of creatinine, a waste product of resonance imaging (MRI), can be used normal muscle breakdown, which may to further study the mass. Imaging tests indicate kidney disease. are performed in an outpatient center • Biopsy. A biopsy is a procedure that or hospital by a specially trained tech- involves taking a piece of kidney tissue nician, and the images are interpreted for examination with a microscope. The by a radiologist—a doctor who special- biopsy is performed by a health care izes in medical imaging. Anesthesia provider in a hospital with light seda- is not needed, though light sedation tion and local anesthetic. The health may be used in some cases. Imaging care provider uses imaging techniques tests may show a tumor, a kidney or such as ultrasound or a computerized bladder stone, an enlarged prostate, tomography (CT) scan to guide the or other blockage of the normal flow biopsy needle into the kidney. The of urine. For more information about kidney tissue is examined in a lab by a imaging tests used to examine the pathologist—a doctor who specializes urinary tract, see the NKUDIC fact in diagnosing diseases. The test helps sheet Imaging of the Urinary Tract at diagnose the type of kidney disease www.urologic.niddk.nih.gov. causing hematuria. 3 Hematuria: Blood in the Urine How is hematuria treated? • When blood is visible in the urine or a dipstick test of the urine indicates Hematuria is treated by treating its underly- the presence of RBCs, the urine is ing cause. If no serious condition is causing examined with a microscope to make hematuria, no treatment is needed. Hema- an initial diagnosis of hematuria. The turia caused by a UTI is treated with antibi- next step is to diagnose the cause of the otics; urinalysis should be repeated 6 weeks hematuria. after antibiotic treatment ends to be sure the infection has resolved. • If a thorough medical history suggests a cause that does not require treatment, the urine should be tested again after Eating, Diet, and Nutrition 48 hours for the presence of RBCs. If Eating, diet, and nutrition have not been two of three urine samples show too shown to play a role in causing or preventing many RBCs when viewed with a micro- hematuria. scope, more serious causes should be explored. Points to Remember • One or more of the following tests • Hematuria is blood in the urine. may be ordered: urinalysis, blood test, biopsy, cytoscopy, and kidney imaging • Most people with microscopic hematu- tests. ria do not have symptoms. People with gross hematuria have urine that is pink, • Hematuria is treated by treating its red, or cola-colored due to the presence underlying cause. of red blood cells (RBCs). • Hematuria can be caused by menstrua- Hope through Research tion, vigorous exercise, sexual activity, In recent years, researchers have learned viral illness, trauma, or infection, such a great deal about kidney disease. The as a urinary tract infection (UTI). More National Institute of Diabetes and Digestive serious causes of hematuria include and Kidney Diseases (NIDDK) sponsors – cancer of the kidney or bladder several programs aimed at understanding kidney and urologic problems that can lead – inflammation of the kidney, urethra, to hematuria. The NIDDK’s Division of bladder, or prostate Kidney, Urologic, and Hematologic Diseases – polycystic kidney disease supports basic research into normal kidney function and the diseases that impair normal – blood clots function at the cellular and molecular levels, – blood clotting disorders, such as including diabetes, high blood pressure, glo- hemophilia merulonephritis, and cystic kidney diseases.