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Blood in urine (Hematuria)- Diagnosis & Tests

This post is also available in: हिन्दी (Hindi)

How is hematuria diagnosed?

To diagnose haematuria and the underlying cause the doctor may do the following examinations:

1. Medical history:

The doctor would ask you certain questions that may help him to form a probable diagnosis. He may also ask about any associated symptoms such as flank pain or burning sensation while urination. Any history of consumption of medicine/ food or being engaged in any activity that can predispose to hematuria. The doctor would note your age and other risk factors such as family history.

2. Physical examination:

• Abdominal examination: Here the doctor will examine your abdomen by applying mild pressure and by tapping it at places.

• Digital rectal examination: This test is done in males to check for any abnormality of the prostate such as enlargement, cancer, or inflammation. Here the doctor puts a well-lubricated finger covered with glove into the rectum to feel the prostate and check for its abnormality.

• Pelvic examination: This test is done in females to check for any abnormality in the pelvic organs which can predispose to hematuria. Here the doctor first looks at the pelvic organs and then puts a well-lubricated finger covered with glove into the vagina to feel for any abnormally of vagina, cervix, or uterus.

3. Urinalysis:


• This test checks for the presence of red blood cells under the microscope and confirms or detects the presence of blood in the urine.

• It also checks for other abnormalities in the urine to look for any underlying cause of hematuria.

• Sample collection: You would be asked to take a mid-stream sample of the urine to avoid the contamination of urine. The doctor would also ask you to avoid the first-morning sample of urine or urine sample after sexual activity or vigorous exercise.
Any woman on her menstrual period is asked to do the test once her period is over.

• Results:

Microscopic hematuria: a test result showing 3 or more RBC’s per high power field, confirms microscopic hematuria in an otherwise normal-looking urine sample.

– Shape of the RBCs also suggests likely underlying cause of the blood in the urine. If the shape of RBCs is abnormal along with the presence of cellular casts and proteins (more than 1+) it indicates glomerular disease (kidney parenchyma disease). If the RBCs are predominately normal in shape it suggests a cause outside glomeruli such as stone, UTI, and others.

– Presence of pus cells and bacteria suggests the presence of UTI.

Gross hematuria: presence of blood in urine at the beginning or end of urination may suggest urethritis or cystitis as the cause. Blood present throughout the act of voiding suggests a cause present at the level of the bladder, ureter or, kidneys.

The sample of urine with blood is collected in the same fashion described above and is taken to the lab. There the sample is rapidly spun to separate the RBC sediment at the bottom of the urine sample which confirms the presence of blood.

Sometimes, after spinning, the red color is seen at the top of the sample which is tested using a dipstick. This may show either presence of free hemoglobin or myoglobin (pigments) that may suggest a disease of muscle breakdown called rhabdomyolysis. Alternatively, this may occur due to the consumption of food or medicines such as beetroot, rifampicin, and others.

4. Imaging tests:

• Ultrasound KUB: ultrasound of kidney ureter and bladder is one of the commonly done tests in the case of hematuria. The test would check for any abnormalities such as kidney disease, kidney stones, mass lesions, presence of any infection in the region of the urinary tract. This is often the first imaging test advised by the doctor however itcan’t accurately rule out the presence of cancer in all cases.It is considered a good test to check for kidney parenchyma abnormality such as glomerulonephritis.


• CT scan: a special type of CT scan is done called CT urography, where multiple scans are taken at different times after injecting dye into the bloodstream. This test is highly recommended to check for people with non-glomerular conditionssuch as cancer, stone, and others. The test is contraindicated in people with allergy to dye, poorly functioning kidneys or, pregnancy.

• MRI: MR urography can be done in cases where the CT is contraindicated. This test does not use iodinated contrast or X-rays as seen in a CT scan.

5. Cystoscopy:

Cystoscopy is a procedure done by a specialist doctor called urologist. Here, the doctor passes a thin tube with a camera, inside your bladder through the urethra. This test helps in visualization of any abnormality inside the bladder such as cancer or growth and allows its sample collection. The collected sample is seen under a microscope and a diagnosis of cancer and the type of cancer can be made.

Contraindication: the test is contraindicated in acute infection or to an extent in urethral narrowing (stricture) or intolerance to pain.

6. Kidney biopsy:

This test involves the passing of a special needle through the skin into the kidney to collect a sample of tissue. The tissue is then seen under a microscope to look for any abnormality. This test is sometimes done in cases to look for evidence of a kidney disease causing hematuria.

Read more: Blood in urine (Hematuria) – Causes, Signs and Symptoms

Read more: Blood in urine (Hematuria)- Treatment


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