What is hematuria?

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), bladder (cystitis), and urethra (urethritis). UTIs generally are caused by bacteria 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 lithotripsy (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 kidneys 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 trauma to the kidneys is treated based on careful consideration of various options, and treatment may include surgery.

Bibliography

"Blood in Urine (Hematuria)." Mayo Clinic, September 1, 2011.

Domino, Frank, ed. The Five-Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2006.

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.

Shannon, Diane W. "Blood in Urine (Hematuria—Adult)." Health Library, January 10, 2013.

U.S. Department of Health and Human Services. "Hematuria: Blood in the Urine." National Kidney and Urologic Diseases Information Clearinghouse, April 16, 2012.