Seeing blood in your urine can be alarming. While in many instances the cause is harmless, blood in urine (hematuria) can indicate a serious disorder.
Many causes of hematuria can be enlisted. However he is harboring renal stone which may be the reason for blood in urine especially in presence of infection. Looking at the age (smoking history not. Hematuria is the presence of blood in the urine. If your child has blood in her urine, it can go away on its own, or it might be the only symptom of a problem that a doctor needs to check. What are the signs and symptoms of Pediatric Hematuria (Blood in Urine)?
Blood that you can see is called gross hematuria. Urinary blood that’s visible only under a microscope (microscopic hematuria) is found when your doctor tests your urine. Either way, it’s important to determine the reason for the bleeding.
Treatment depends on the cause.
Symptoms
Gross hematuria produces pink, red or cola-colored urine due to the presence of red blood cells. It takes little blood to produce red urine, and the bleeding usually isn’t painful. Passing blood clots in your urine, however, can be painful.
Bloody urine often occurs without other signs or symptoms.
When to See a Doctor
Make an appointment to see your doctor anytime you notice blood in your urine.
Some medications, such as the laxative Ex-lax, and certain foods, including beets, rhubarb and berries, can cause your urine to turn red. A change in urine color caused by drugs, food or exercise might go away within a few days.
Bloody urine looks different, but you might not be able to tell the difference. It’s best to see your doctor anytime you see red-colored urine.
Causes
In hematuria, your kidneys — or other parts of your urinary tract — allow blood cells to leak into urine. Various problems can cause this leakage, including:
- Urinary tract infections. These occur when bacteria enter your body through the urethra and multiply in your bladder. Symptoms can include a persistent urge to urinate, pain and burning with urination, and extremely strong-smelling urine.
For some people, especially older adults, the only sign of illness might be microscopic blood in the urine.
- Kidney infections(pyelonephritis). These can occur when bacteria enter your kidneys from your bloodstream or move from your ureters to your kidney(s). Signs and symptoms are often similar to bladder infections, though kidney infections are more likely to cause a fever and flank pain.
- A bladder or kidney stone. The minerals in concentrated urine sometimes form crystals on the walls of your kidneys or bladder. Over time, the crystals can become small, hard stones.
The stones are generally painless, so you probably won’t know you have them unless they cause a blockage or are being passed. Then there’s usually no mistaking the symptoms — kidney stones, especially, can cause excruciating pain. Bladder or kidney stones can also cause both gross and microscopic bleeding.
- Enlarged prostate. The prostate gland — which is just below the bladder and surrounding the top part of the urethra — often enlarges as men approach middle age. It then compresses the urethra, partially blocking urine flow. Signs and symptoms of an enlarged prostate (benign prostatic hyperplasia, or BPH) include difficulty urinating, an urgent or persistent need to urinate, and either visible or microscopic blood in the urine. Infection of the prostate (prostatitis) can cause the same signs and symptoms.
- Kidney disease. Microscopic urinary bleeding is a common symptom of glomerulonephritis, an inflammation of the kidneys’ filtering system. Glomerulonephritis may be part of a systemic disease, such as diabetes, or it can occur on its own. Viral or strep infections, blood vessel diseases (vasculitis), and immune problems such as IgA nephropathy, which affects the small capillaries that filter blood in the kidneys (glomeruli), can trigger glomerulonephritis.
- Cancer. Visible urinary bleeding may be a sign of advanced kidney, bladder or prostate cancer. Unfortunately, you might not have signs or symptoms in the early stages, when these cancers are more treatable.
- Inherited disorders. Sickle cell anemia — a hereditary defect of hemoglobin in red blood cells — causes blood in urine, both visible and microscopic hematuria. So can Alport syndrome, which affects the filtering membranes in the glomeruli of the kidneys.
- Kidney injury. A blow or other injury to your kidneys from an accident or contact sports can cause visible blood in your urine.
- Medications. The anti-cancer drug cyclophosphamide and penicillin can cause urinary bleeding. Visible urinary blood sometimes occurs if you take an anticoagulant, such as aspirin and the blood thinner heparin, and you also have a condition that causes your bladder to bleed.
- Strenuous exercise. It’s rare for strenuous exercise to lead to gross hematuria, and the cause is unknown. It may be linked to trauma to the bladder, dehydration or the breakdown of red blood cells that occurs with sustained aerobic exercise.
Isolated Hematuria
Runners are most often affected, although anyone can develop visible urinary bleeding after an intense workout. If you see blood in your urine after exercise, don’t assume it’s from exercising. See your doctor.
Often the cause of hematuria can’t be identified.
Risk Factors
Almost anyone — including children and teens — can have red blood cells in the urine. Factors that make this more likely include:
- Age. Many men older than 50 have occasional hematuria due to an enlarged prostate gland.
- A recent infection. Kidney inflammation after a viral or bacterial infection (post-infectious glomerulonephritis) is one of the leading causes of visible urinary blood in children.
- Family history. You might be more prone to urinary bleeding if you have a family history of kidney disease or kidney stones.
- Certain medications. Aspirin, nonsteroidal anti-inflammatory pain relievers
and antibiotics such as penicillin are known to increase the risk of urinary bleeding. - Strenuous exercise. Long-distance runners are especially prone to exercise-induced urinary bleeding. In fact, the condition is sometimes called jogger’s hematuria. But anyone who works out strenuously can develop symptoms.
There are many reasons why a person can have blood in their urine. This condition, known as hematuria, can be an indication of a serious problem or conversely, have no negative connotation. What should you do if you find out that there's blood in your urine?
What is hematuria?
Hematuria is defined as the presence of red blood cells in the urine. It can be characterized as either 'gross' (visible to the naked eye) or 'microscopic' (visible only under the microscope). Microscopic hematuria is an incidental finding often discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria could prompt you to visit the doctor. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra. It is estimated that hematuria occurs in 2.5 to 21 percent of the population. In many patients no specific cause is found; however, hematuria may be a marker for infection, stone disease or urinary tract cancer. Risk factors for significant underlying disease include: smoking, radiation, overuse of some pain medicines and exposure to certain chemicals.
What are the common causes of hematuria?
Blood in the urine is often not a sign of significant disease. Studies have shown that between nine to 18 percent of normal individuals can have some degree of hematuria. However, hematuria can be a sign of an important medical condition requiring treatment. Below is a list of common causes of hematuria:
- Cancer (Bladder/Kidney/Urethra/Ureter)
- Urinary Stone Disease
- Urinary Tract Infection (UTI)
- Renal (Kidney) Disease
- Radiation or Chemical Induced Cystitis (Bladder Irritation)
- Injury to the Urinary Tract
- Exercise-Induced
How is hematuria diagnosed?
Visible hematuria is often worrisome to the patient and prompts them to seek medical attention; however, microscopic hematuria can be just as severe. It often has no symptoms and is detected on a urine dipstick test. If the dipstick test is positive for blood the amount of blood is often determined by looking at the urine with a microscope. If three or more red blood cells (RBC) are seen per high power field on two of three specimens, further evaluation to determine a cause is recommended.
What additional tests are needed?
Any patient with gross hematuria or significant microscopic hematuria should have further evaluation of the urinary tract. The first step is a careful history and physical examination. Laboratory analysis consists of a urinalysis and examination of urinary sediment under a microscope. The urine should be evaluated for protein (a sign of kidney disease) and evidence of urinary tract infection. The number of red blood cells per high-powered field should be determined. In addition the shape of the blood cells should be evaluated. This can help determine where the bleeding is coming from. In patients with white blood cells in the urine, a urine culture should be performed as well. A urinary cytology is also obtained to look for abnormal cells in the urine. A blood test should also be done to measure serum creatinine (a measure of kidney function). Those patients with significant protein in their urine, abnormally shaped red blood cells, or an elevated creatinine level should undergo general medical evaluation for the presence of kidney disease.
A complete urologic evaluation for hematuria also includes X-rays of the kidneys and ureters to detect kidney masses, tumors of the ureters and the presence of urinary stones. This traditionally consisted of an intravenous pyelogram (IVP). In this study, a radiographic dye is injected into the blood stream and X-rays are taken as the kidneys excrete the dye. This study has trouble detecting small renal masses and is often combined with a renal ultrasound.
Many physicians may opt for other imaging studies such as a computerized tomography (CT) scan. This is the preferred method of evaluating kidney masses and is the best modality for the evaluation of urinary stones. Recently many urologists have been using CT urography. This allows the urologist to look at the kidneys and ureters with one X-ray test. In patients with an elevated creatinine or an allergy to X-ray dye, magnetic resonance imaging (MRI) or retrograde pyelography is used to evaluate the upper urinary tract. During retrograde pyelography, the patient is taken to the operating room and dye is injected up the ureters from the bladder and then images are taken.
The main limitation of these imaging studies is the inability to evaluate the bladder; therefore a cystoscopic evaluation is required. This is usually performed in the office under local anesthesia with either a rigid, or more commonly, a flexible cystoscope. After applying a topical analgesic to the urethra the urologist inserts an instrument called a cystoscope through the urethra and into the bladder. Looking through the cystoscope the doctor can examine the inner lining of the bladder and urethra for abnormalities.
Occasional Gross Hematuria
What happens if no abnormality is found?
Causes For Occasional Hematuria
In at least eight to 10 percent of cases no cause for hematuria is found. Some studies have demonstrated an even higher percentage of patients have no cause. Unfortunately, studies have shown that urologic malignancy is later discovered in one to three percent of patients with negative work-ups. Therefore, some form of follow-up is recommended. Recommendations regarding follow-up are sparse and no clear consensus has been agreed upon. Consideration should be given to repeating the urinalysis and urine cytology at six, 12, 24 and 36 months. Immediate re-evaluation with possible cystoscopy and repeat imaging should be performed in the face of gross hematuria, abnormal urinary cytology or irritating urinary symptoms such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is needed.