Hematuria
Hematuria is the presence of blood or red blood cells in the urine, which can manifest as visibly bloody urine or be detected only through microscopic analysis. This condition can originate from various parts of the urinary system, including the kidneys and bladder, and may present with symptoms such as pain, fever, and urinary urgency, or it may be asymptomatic. The causes of hematuria are diverse and can range from benign conditions like urinary tract infections (UTIs), kidney stones, and benign familial hematuria to more serious issues such as bladder or kidney cancer and trauma.
Common symptoms associated with hematuria include discomfort during urination and frequent urges to urinate, especially in the context of infections. Treatment strategies depend on the underlying cause; options may include antibiotics for UTIs, reassurance for benign conditions, or more invasive interventions like surgery and chemotherapy for malignancies. The duration and severity of hematuria can vary significantly, which highlights the importance of proper medical evaluation to determine the appropriate management. Understanding this condition is vital for addressing potential health risks and ensuring timely care.
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Subject Terms
Hematuria
ANATOMY OR SYSTEM AFFECTED: Bladder, blood, kidneys, urinary system
DEFINITION: The presence of blood or red blood cells in the urine
CAUSES: Urinary tract infection, kidney stones, benign familial hematuria, benign prostatic hyperplasia (enlarged prostate), medication, exercise, cancers, trauma
SYMPTOMS: May be asymptomatic; pain, fever, urinary frequency/urgency
DURATION: Days to years, depending on cause and treatment
TREATMENTS: Depends on cause; reassurance, antibiotics, chemotherapy, radiation, surgery
Causes and Symptoms
Hematuria can present as bloody urine that is visible to the naked eye, or it can be subtle, detectable only by microscopic analysis. The source of the blood can be from any part of the urinary system, including the kidneys, bladder, and urethra. Hematuria can be accompanied by a variety of symptoms, or it can be completely asymptomatic.
The presentation, source, and symptoms of hematuria are functions of its broad range of causes. Possibly the most common cause of hematuria is a urinary tract infection (UTI), which includes infections of the kidney (pyelonephritis), (cystitis), and (urethritis). UTIs generally are caused by such as Escherichia coli and are accompanied by symptoms such as fever, pain with urination, and urinary frequency or urgency.
Another common cause of hematuria is kidney stones (nephrolithiasis). Stones are most commonly composed of calcium and can present with severe pain, nausea, and vomiting.
Hematuria can also be the presenting symptom of innocent causes such as benign familial hematuria (a mild inherited condition), benign prostatic hyperplasia (BPH or enlarged prostate, a common condition in middle-aged and elderly men), medication, and exercise. In other situations, it can be the first sign of life-threatening problems such as bladder or kidney cancer and trauma.
Treatment and Therapy
The therapeutic options for treating hematuria depend on its cause. For a UTI, treatment can be a course of oral antibiotics, or it may require hospitalization and intravenous antibiotics in the case of a severe infection. In the case of kidney stones, the stones will usually pass on their own, but in some cases interventions such as surgery or (breaking up the stones) are necessary to clear the obstruction.
If the cause is benign familial hematuria or exercise, then reassurance may be all the treatment that is required. BPH may also be treated with reassurance and lifestyle change, or medication and surgical intervention may be initiated to help reduce the size of the prostate. If medication is the cause of hematuria, the condition may be self-limited, or a patient may be advised to change or stop the medication.
Cancers of the bladder and are treated with chemotherapy, radiation, surgery, immunotherapy, or a combination of these options, depending on the type and severity of the cancer. Hematuria as a sign of to the kidneys is treated based on careful consideration of various options, and treatment may include surgery.
Bibliography
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Kilmartin, Angela, ed. The Patient’s Encyclopaedia of Urinary Tract Infection, Sexual Cystitis, and Interstitial Cystitis. London: Angela Kilmartin, 2002.
Lopez, Ralph. “The Kidneys.” In The Teen Health Book: A Parents’ Guide to Adolescent Health and Well-Being, edited by Kate Kelly. New York: W. W. Norton, 2003.
O'Leary, Michael P. "Patient Education: Blood in the Urine (Hematuria) in Adults (Beyond the Basics)." UpToDate, 1 July 2023, www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics/print. Accessed 2 Apr. 2024.
“Urine—Bloody.” Medline Plus, 1 July 2023, medlineplus.gov/ency/article/003138.htm. Accessed 2 Apr. 2024.