Haematuria implies the presence of blood in urine and is a matter of concern for an individual’s health. Blood is meant to stay in the blood vessels (tubes which carry blood in the body). Some individuals report the presence of blood in the urine. In medical terms, this is known as haematuria.1 Detection of urine in the blood can be visible in the form of blood droplets or a change in the colour of urine. Sometimes, microscopic examination is sought to find out whether there is blood in the urine. Haematuria should not be ignored by the patient, and the patient should seek immediate medical attention from a healthcare provider.
Causes of haematuria
Haematuria may be caused by several factors.1,2 Usually, urine in the blood indicates kidney (renal) complications. However, there may be many other reasons behind haematuria. Some of the factors causing haematuria are:
- The patient may have urinary tract stones or has undergone a recent urinary tract procedure
- After vigorous exercise
- The patient may have inflammation in the bladder, urethra, ureter, or other parts of the urinary system.
- The patient may be affected by blood disorders such as sickle cell disease or haemophilia.
- Cancer of the bladder, urethra, or ureter may cause the appearance of blood in the urine.
- Pyelonephritis is defined as a bacterial infection causing inflammation in the kidneys and may be a reason behind the presence of blood in the urine.
- Inflammation of the bladder is known as cystitis. It may cause haematuria
- Benign prostate hypertrophy is a condition where the semen-producing part of the male body becomes enlarged. An enlarged prostate exerts pressure on the other parts of the urinary system and may cause injury and the appearance of blood in the urine.
- In an accident, a person may get a renal injury, which may manifest as haematuria.
- Kidney disease or trauma
Signs and symptoms of haematuria
The major and decisive symptom of haematuria is the presence of blood in the urine. However, healthcare providers have associated other symptoms with haematuria, such as nausea, vomiting, etc.3 In some cases, patients may experience back pain or bladder pain. This occurs when there are blood clots in the urine, as they may cause disturbance and pain during urination. Patients may feel the urgency to urinate in a case of haematuria.
Your healthcare provider will take a thorough history and medical examinations to diagnose you with haematuria.4 The diagnostic procedures are done to better understand the symptoms and their possible treatment options. The following diagnostic tests or methods are used to confirm the presence of haematuria:
- Urinalysis – a urine sample is tested in the lab
- Urine culture – an analysis of urine to check for the presence of infectious agents causing haematuria
- Urine cytology – carried out on a urine sample to detect the abnormal growth of cells
- Cystoscopy – in this test, a cystoscope is used to conduct an internal examination of the bladder and urethra
- Ultrasound – ultrasounds are used to check the organs like kidneys, bladder, urethra, and ureter
- CT scan – Computerised Tomography creates cross-sectional images of your abdomen and pelvis by using X-rays and computers
- MRI scan – Magnetic Resonance Imaging uses magnets and computers to create images of your organs and structures
- Blood test – a blood sample is taken to check if there is an increased creatinine level, increased blood cell count, or other abnormalities that indicate the presence of conditions such as sickle cell anaemia.
- Dipstick test – sometimes, blood may be present in the urine, but it is not visible to the human eye. For that, urine is placed into a container, and a chemically treated stick is positioned in the container. Upon the presence of blood, the colour of the stick will change. Colour changes of the dipstick will indicate the presence or absence of blood in the urine.
Management and treatment for haematuria
Once the healthcare provider has determined the underlying cause of the patient’s haematuria, treatment can be immediately initiated.4 Haematuria caused by infectious agents can be cured by the use of proper antimicrobials such as antibiotics, etc.
If the presence of urine is due to kidney stones, then the removal of kidney stones can solve the problem. Increased intake of water can remove stones via urination. Surgery or lithotripsy may be considered adequate alternatives.
Haematuria caused by trauma or injury is treated based on the severity and duration of the trauma. In severe cases, surgery is performed.
If there is a tumour or cancer present in the kidney and it is causing haematuria, then the cancer is treated depending upon the stage, type, patient’s health, age, etc. The therapies used for the treatment of cancer are immunotherapy, chemotherapy, radiation therapy, and surgery.
If an infection is behind the appearance of urine in the blood, then antibiotics are given to treat the infection and thus cure haematuria.
The common risk factors include the following:5
- Recent infections – such as post-infectious glomerulonephritis and IgA nephropathy
- Exercise – athletes doing long-distance running may get exercise-induced haematuria.
- Age – some people assigned male at birth (AMAB) above the age of 50 have enlarged prostates. An enlarged prostate causes trouble and injury, resulting in bleeding through the rest of the urinary tract.
- Patients that have a history of chronic kidney disease, renal cancer, renal trauma, etc
- Prostatitis – an infection of the prostate may be considered a risk factor for causing haematuria.
- Accident – an accident where the site of injury is a renal portion may be a risk factor that causes haematuria
If left untreated or ignored, haematuria can lead to two common complications.6.7 One is kidney failure, affecting the renal functions of water and electrolyte balance, removal of metabolic waste products, etc. The other one is cancer. The appearance of blood in urine may indicate the presence of malignancy in some parts of the urinary tract. If left undiagnosed, the initial development of cancer may be ignored, and this can lead to metastasis. A person should not ignore the appearance of blood in the urine and should consult with a healthcare provider to get it sorted out. An initial diagnosis can prevent the development of an incurable condition.
How can I prevent haematuria?
You can prevent haematuria by drinking plenty of water, avoiding unhygienic conditions, avoiding food or substances that can cause kidney stones, etc. One should also maintain their diet and exercise regularly.
How common is haematuria?
Haematuria is not uncommon and occurs in 1 out of 5 people.
When should I see a doctor?
You should immediately see your doctor on the first appearance of blood in the urine. You should not prolong medical attention. Immediate medical attention can prevent a lot of complications in patients.
Haematuria, the presence of blood in urine, is a concerning health condition that should not be ignored. It can be detected through visible blood droplets or a change in the colour of urine and sometimes requires microscopic examination for confirmation.
Haematuria can be caused by various factors, including urinary tract stones, recent procedures or vigorous exercise, inflammation in the urinary system, blood clotting disorders, cancer of the bladder or urinary tract, sickle cell disease, pyelonephritis (kidney infection), cystitis (bladder inflammation), benign prostate hypertrophy, renal injury, kidney disease, or kidney trauma.
The primary symptom of haematuria is the presence of blood in the urine, but other associated symptoms may include nausea, vomiting, back or bladder pain, and urgency to urinate.To diagnose haematuria, healthcare providers conduct a thorough history and medical examinations. Diagnostic procedures include urinalysis, urine culture, urine cytology, cystoscopy, ultrasound, CT scan, MRI scan, blood tests, and dipstick tests. These tests help confirm the presence of haematuria and identify any underlying conditions contributing to the symptoms.
Several risk factors increase the likelihood of developing haematuria, including recent infections, exercise (particularly in long-distance runners), age (especially in people AMAB above 50 with enlarged prostate), a history of chronic kidney disease, renal cancer, renal trauma, prostatitis, or accidents affecting the renal area.
Failure to address haematuria can lead to complications such as kidney failure, impaired renal functions, and the development of cancer. Timely medical intervention can prevent the progression of potentially incurable conditions. It is crucial not to ignore the presence of blood in the urine and to consult a healthcare provider for proper diagnosis and treatment.
- Saleem MO, Hamawy K. Hematuria. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 26]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534213/
- Bolenz C, Schröppel B, Eisenhardt A, J. Schmitz-Dräger B, Grimm MO. The investigation of hematuria. Dtsch Arztebl Int [Internet]. 2018 Nov [cited 2023 Oct 26];115(48):801–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365675/
- Matulewicz RS, Meeks JJ. Blood in the urine(Hematuria). JAMA [Internet]. 2016 Oct 11 [cited 2023 Oct 26];316(14):1508. Available from: https://doi.org/10.1001/jama.2016.4716
- Nielsen M, Qaseem A, for the High-Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physicians. Ann Intern Med [Internet]. 2016 Apr 5 [cited 2023 Oct 26];164(7):488. Available from: http://annals.org/article.aspx?doi=10.7326/M15-1496
- Horváth O, Szabó AJ, Reusz GS. How to define and assess the clinically significant causes of hematuria in childhood. Pediatr Nephrol [Internet]. 2023 Aug 1 [cited 2023 Oct 26];38(8):2549–62. Available from: https://doi.org/10.1007/s00467-022-05746-4
- Kim H, Lee M, Cha MU, Nam KH, An SY, Park S, et al. Microscopic hematuria is a risk factor of incident chronic kidney disease in the Korean general population: a community-based prospective cohort study. QJM: An International Journal of Medicine [Internet]. 2018 Jun 1 [cited 2023 Oct 26];111(6):389–97. Available from: https://academic.oup.com/qjmed/article/111/6/389/4936876
- Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. AFP [Internet]. 2013 Dec 1 [cited 2023 Oct 26];88(11):747–54. Available from: https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html