Haematuria

Haematuria (blood in urine) is a common condition and one which must be taken seriously. Although in the majority of cases no sinister cause is found it must be investigated to exclude treatable disorders.

Haematuria is usually divided into macroscopic (visible) and microscopic (where the blood is found only on dipstick or microscopic examination). Further clinically relevant distinctions can be made between painful and painless haematuria, and haematuria of renal (medical) and post-renal (urological) origin.

Routine haematuria investigation usually involves flexible cystoscopy, to look at the bladder and a scan to look at the kidneys and ureters.

Investigations

Investigations for haematuria include:

A general physical examination includes blood pressure and a digital rectal examination of the prostate.
A mid stream specimen of urine for microscopy of red, white blood cells and bacteria. The presence of any crystals and the level of protein in the urine will be assessed. Urine may sometimes be inspected for the presence of cancerous cells as well.
Routine blood tests may be required to assess kidney function, bleeding problems, anaemia or other related conditions.
This test involved using a probe placed on the body surface to generate sound waves whose reflection off tissues is then converted into an image. It is painless, non-invasive and does not use radiation. As such it is the initial scan of choice for patients under 40 years of age.
Computed Tomography scans are highly detailed x-rays that show the internal organs of the body. Dyes may be injected to help see the area more clearly. CT imaging is preferred for patients over 40 years of age and if abnormalities are detected at ultrasound.
In cystoscopy, a long, thin, flexible optical scope is inserted through the urethra and into the bladder. Visual examination of the urethra, bladder, and kidneys is undertaken to locate the site of bleeding. This is a 5 minute outpatient procedure that is performed under local anaesthetic and does not require an incision.
If either the imaging or flexible cystoscopy suggest a bladder lesion this will lead to examination under anaesthetic and operative removal of the lesion for both treatment and diagnosis. Other conditions may lead to other forms of investigation and treatment.

Points to consider about haematuria:

Haematuria may not always be due to a problem that needs treatment
It can occur due to urine infection
Some medicines and foods can colour the urine red. This is not the same as passing blood
It can occur following strenuous exercise
Patients on anticoagulants whose control is in the normal therapeutic range and who have haematuria must be fully investigated as above since haematuria is not a normal consequence of anticoagulation

Haematuria can originate from the kidney itself (eg glomerulonephritis) due to inflammation 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, elevated blood pressure or abnormal renal function tests. This group of conditions is usually managed by a nephrologist (renal physician) and may be referred to as a medical renal disease.