Get the facts, answers, and treatment for hematuria as discussed by Dr. Prince Singh, a nephrologist and kidney disease specialist.
What is hematuria?
Hematuria (hee·muh·tur·ee·uh) is the presence of blood in urine. See Figure 1
Figure 1: Glomerular red cells in urine—different types of acanthocytes (left) and a red cell cast (right; inset shows a hemoglobin cast).
Is it normal to have hematuria?
No. Generally, blood should not be present in the urine. However sometimes there can be hematuria which is transient in nature and can be related to trauma, sexual activity, menstruation in women and exercise.
What is epidemiology of hematuria?
Data showing prevalence of hematuria in the general population is not uniform as the results are method dependent, whether dipsticks or microscopy was used for checking urine samples.
Based on these studies, a high prevalence of proteinuria has been shown in the general population (0.8% to 16%). An important caveat though is that the prevalence of hematuria increases with age.
What are the subtypes of hematuria?
Yes, these subtypes are:
Visible hematuria
Non-visible hematuria
What is visible hematuria?
Visible hematuria should be taken seriously and work-up should be undertaken to find the cause of it. However, there are certain benign situations where one can have visible blood in urine.
Such conditions are:
Beetroot consumption
Rhubarb
Medications such as rifampicin (used in treatment of tuberculosis) and phenytoin (epilepsy/seizure medication)
Other “not so benign” conditions where visible blood can be seen
Stones in kidney or urinary tract
UTIs (Urinary tract infections)
Cysts in kidney
Malignancy or tumor in genital-urinary tract
What is non-visible hematuria?
Non-visible hematuria can be seen in some of the above conditions (UTIs or stones) but generally tend to portend some form of direct kidney involvement in the form of IgA nephropathy, Thin Basement Membrane Disease or other conditions causing glomerulonephritis. See in Figure 2.
Figure 2: Causes of hematuria. More common causes are shown in larger fonts. On the right hand column are shown causes that differ in frequency in older patients. The division at 40 years is arbitrary but is chosen by some guidelines.
How can you evaluate hematuria?
As noted previously, visible hematuria should be addressed as it may point towards organic causes such as malignancy or stricture. Evaluation begins with urine assessment which can be microscopic examination looking for red blood cells or dipstick urinalysis.
After transient causes have been ruled out, examination (evaluation) by a urologist is the next step involving imaging such as CT Urogram and in many cases bladder examination by cystoscopy.
What does having hematuria imply?
Fortunately, hematuria alone does not translate to a higher risk of kidney failure.
However in one of the largest studies to date from Israel (study by Vivante et al, 2011), a higher risk of kidney failure was seen over the period of 21 years in patients with hematuria versus those without.
In another study from Japan (Iseki, 2012), the combination of both hematuria and proteinuria conveyed approximately twice the risk of developing end stage kidney disease than the risk of proteinuria alone.
What is the treatment for hematuria?
The goal of treating hematuria is to identify the cause of hematuria and subsequently treat the cause. Oftentimes, this will need collaboration of both nephrologist and urologist.
When do you need to see a kidney disease specialist?
Contact your healthcare provider if you notice signs and symptoms as described. Referral to a kidney specialist will be needed for proper diagnosis and treatment of hematuria. You should see a kidney doctor if hematuria is associated with proteinuria and or elevated serum creatinine or decreased GFR.
Get in touch with Kidney Solutions Online
Dr. Prince Singh is a kidney disease specialist who specializes in treatment of kidney diseases and related conditions such as proteinuria. Book a consultation with Dr. Singh or call 507-316-3907.
For more information, visit the National Kidney Foundation. Information coincides with Oxford University Press and the Oxford Textbook of Clinical Nephrology as covered here.
Check out our previous blog post about essential facts, answers, and treatment for proteinuria, another kidney condition.
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