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

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What is hematuria?

Hematuria is the presence of blood in the urine.

When the blood is present in the gross amount it changes the color of the urine to a red, pink, or brown color which is called gross hematuria.

Many times the blood may be present in the urine and urine may still appear normal in color. In these cases, the blood can be onCly be detected under a microscope. This is called microscopic hematuria. Clinically, it is defined as the presence of 3 or more RBCs per high power field when seen under a microscope.

Both types of hematuria are important and can indicate a serious underlying condition.
What is hematuria

What causes hematuria?

There are a number of different causes that lead to blood in the urine. These are given below:

Urinary tract infection: one of the commonest causes of blood in the urine. It can occur as a result of an infection in the bladder, kidney, or even prostate. It is responsible for 25% of cases of blood in urine in adults and 50% of cases in children that have no history of injury.

• Kidney stones: is responsible for 20% of cases of blood in urine with no history of injury.

• Cancer: cancer of kidneys, bladder, or prostate can lead to blood in the urine. Gross hematuria without pain is considered as a symptom of cancer unless proven otherwise. About 85% of cases of bladder cancers and 40% of cases of kidney cancers (RCC) present with gross hematuria.

• Kidney diseases: Microscopic hematuria is commonly seen due to inflammation of the kidney’s functioning system called glomerulus (glomerulonephritis). This may be caused by diabetes, vasculitis, Ig A nephropathy. Sometimes the cause of glomerulonephritis remains unidentified.

• Kidney injury: a strong hit or blow to the abdomen can lead to injury to the kidneys which can ooze out blood in the urine. This can be seen in road accidents, assaults, or sports.

Enlarged prostate: more commonly seen in men above 50 years of age.

• Vigorous exercise: vigorous exercise may rarely lead to blood in the urine. The cause may be related to injury to the bladder, breakdown of RBCs and dehydration

• Blood- clotting disorders like hemophilia

• Sickle cell disease: a disorder where a person’s RBCs are sickle-shaped which are prone to easy breakdown.

• Polycystic kidney disease: a condition where numerous abnormal cysts develop in kidneys which may bleed.

• Sexual activity: may cause blood in urine if it causes injury to the urethra or bladder.

• Medicines: blood thinners such as aspirin, heparin, and others and anti-cancer drugs such as cyclophosphamide.

• Out of all these causes top four are the commonest causes for blood in the urine.

• Some of the food items and medicines when consumed gives a red or brown color to the urine but doesn’t contain blood:

• Food items such as beetroot, blackberries, aloe, broad beans, and others.

• Medicines such as rifampin, metronidazole, nitrofurantoin, ibuprofen, phenytoinquinine, chloroquine, and others

Still, in about 60% of the cases, no obvious cause is found.

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Who is more prone to develop hematuria?

Hematuria can occur in almost any person from children to elders. However, there are some factors that make a person prone to develop hematuria. These are given below:

• Age. People older than 35 years have a higher risk of developing urinary tract cancer which often presents as blood in the urine. Elderly males are also prone to develop enlargement of the prostate gland which may sometime present as hematuria.

• Family history: a person may be more prone to develop a kidney stone or a kidney disease due to his family history. These people are in turn more prone to develop blood in the urine.

• Kidney infection: a viral or bacterial infection of the glomeruli may also predispose a person for hematuria.

• Some medicines: certain medicines make a person more prone for hematuria such as warfarin, aspirin, NSAIDs, and others.

• Vigorous exercise: doing exercises that put a lot of stress on the body makes a person more prone to blood in the urine. This is more common in long-distance runners where it is termed as jogger’s hematuria.

How does blood in urine look like?

The blood in urine when present in significant amount (gross hematuria), it changes the color of the urine and makes it appear as red, pink, or brown. It is said that only 1ml of blood in 1 liter of urine can bring a change in the color of urine.

When the blood is present in lesser quantity, it doesn’t change the color of the urine and remains invisible to the naked eyes. This can only be detected under a microscope (microscopic hematuria) when the urine is tested incidentally during a general health examination or for some other disease or condition.

What can be the signs and symptoms associated with hematuria?

Most of the cases of gross hematuria are not associated with other signs and symptoms. However, in many cases following signs and symptoms may be associated with hematuria which may indicate towards the underlying cause:

1. UTI: Hematuria associated with urgency, frequency, painful urination may suggest cystitis. Pain in the flank with fever and chills may suggest kidney infection.

2. Kidney stone: sudden onset of severe pain in the back on sides may suggest underlying kidney stones. This may be accompanied with nausea and vomiting.

3. Bleeding disorder: Bleeding from other parts of the body indicate coagulopathy or bleeding disorder.

4. Trauma or exercise-induced: a history of strenuous exercise or trauma to abdomen suggest respective causes.

5. Medicine or food: a history of consumption of medicines prone for hematuria may suggest drug as the probable cause. History of consumption of certain food items that change the color of urine may also help to suggest the cause.

When you should consult a doctor?

Technically, the presence of visible blood in urine with no pain is considered as a sign of cancer of the urinary tract unless proven otherwise. Up to 30 to 40% of these cases are eventually found to be associated with malignancy.

Whereas, only about 2.6 to 4% of cases of microscopic hematuria have a risk of developing cancer.

However, all cases of blood in urine whether gross or microscopic or associated with pain or not should be evaluated immediately to diagnose the underlying cause.

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.

How is hematuria treated?

The treatment of hematuria depends upon the underlying cause.

No specific treatment: if there is no serious underlying condition present, then no specific treatment is required and the hematuria often resolves on its own.


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