Haematuria is a common condition and one which must be taken seriously. Haematuria simply means blood in urine. If you notice blood in the urine it should always be investigated, although in most cases no serious cause will be found.
Haematuria is usually divided into visible (where the urine is discoloured) and non-visible microscopic (where the blood is found only on dipstick or microscopy examination). Further clinically relevant distinctions can be made between painful and painless haematuria, and haematuria of glomerular and post-glomerular origin.
Haematuria investigation has been made simple with the advent of flexible cystoscopy, where the patients can assessed quickly with a local anaesthetic outpatient procedure.
Causes of Haematuria:
Infections in the urinary tract, which can be either in the kidney, bladder or prostate.Haematuria can originate from the kidney itself due to inflammation in the kidney, eg glomerulonephritis affecting the filtering units (glomeruli). When this is the cause of haematuria there are often other signs of kidney disease such as Protein in urine, High blood pressure or Abnormal renal function.
Kidney cysts, tumours or kidney stones can also cause haematuria. Blockages or stones in the tube to the bladder (ureter) may cause haematuria. The bladder may also be the cause of haematuria, in cystitis (bladder infection), stones, or tumours in the bladder.
Diseases of the prostate gland may also cause haematuria.
The most common cause of blood haematuria in India is stone disease which can be either in the kidney, ureter or the bladder.
Investigations for Haematuria
General Physical Examinationwhich includes blood pressure, pulse, prostate in a male and the gynaecological organs in a female
Urine analysis- A mid stream specimen of urine for microscopy of red, white blood cells and bacteria. The presence of any crystals, ova or parasites should be noted and culture of urine specimen. The level of protein in the urine will be assessed.
Blood tests- All patients should have a complete blood picture, Serum urea, creatinine and electrolytes should be measured, along with albumin, calcium and liver function tests if the patient is unwell or in renal failure.
USS is the base line investigation for haematuria. This gives an indication towards presence of any abnormality and directs further investigations.
Intravenous Pyelogram (IVP)
A special dye is injected your arm that travels through the bloodstream to the urinary tract, which in turn is then picked up through an x-ray. This process allows a doctor to see if there are any abnormalities in the kidney or any other damage to the organ.
CT scans are special x-rays that show the internal organs of your body. Dyes are also injected allowing the doctor to see the area more clearly.
Cystoscopy / Ureteroscopy
Blood in the urine can be caused by problems in the kidneys, ureters, bladder or the prostate. To differentiate these and identify, the doctor may order a cystoscopy or ureteroscopy to determine precisely where the internal bleeding is occurring. In cystoscopy/ ureteroscopy, a long, thin, rigid or flexible optical scope is inserted through the urethra and into the bladder. The doctor then makes a visual examination of the urethra, bladder, and kidneys to locate the site of bleeding.
Points to consider about Haematuria (Blood in urine)
• Haematuria may not always be a bad thing,
• Haematuria can be detected in the urine during a menstrual period
• It can occur only during a urine infection
• Sometimes some medicines and foods can colour the urine red. This is not the same as passing blood
• It can occur following strenuous exercise