Introduction
The medical term 'haematuria' refers to the presence of blood in the urine. It is classified as either 'microscopic haematuria' where the presence of blood is not detectable to the naked eye and is only found via testing, or 'macroscopic haematuria' (also referred to as 'frank', 'visible' or 'gross' haematuria) where there is some visible change in colour of the urine or visible presence of blood.
Haematuria is relatively common – more than 1 in 10 young adults will have an episode of haematuira and this rises to around 1 in 5 of men over 50.
Causes
There are many things that may cause the condition, with the commonest causes including:
- Urothelial cancer of the bladder or kidney
- Urinary tract infections
- Kidney stones
- Abnormal bleeding from the prostate
- Some types of medication (such as blood thinning medication or aspirin and aspirin-type medication)
- Injury (trauma) to the loin / lower abdomen region / penis / scrotum
- Glomerulonephritis (a condition that affects the kidneys often caused by viral infections or autoimmune responses)
In those who experience macroscopic haematuria, there is a 23% chance of a urothelial cancer being present and therefore macroscopic haematuria should always be investigated.
Symptoms
Where there is visible discolouration of the urine, and this is caused by haematuria, it is normally red or brown, however it's important to note that the colour of the urine does not necessarily indicate the presence of blood - there may be other reasons it takes on a red or brown hue.
Tests / Diagnosis
There are a range of tests necessary to determine the underlying cause of haematuria. These include:
Physical examination
Standard testing including blood pressure, pulse and examination of the prostate (male patients) and external genitalia (male and female patients).
Urinalysis and Urine cytology
A urinalysis is a simple test also referred to as 'dipstick testing' and can be used to detect microscopic haematuria. A urine sample will be analysed for composition (i.e. red / white blood cells, protein) and for presence of bacteria, which may indicate infection. Separate urine tests called urine cytology look for the presence of cancer cells in the urine.
Imaging Tests
This will give information on the presence of any stones or sinister lesions within the urinary tract that may be the cause of the haematuria. These tests may include:
- CT KUB
- CT IVP
- Renal tract ultrasound
Cystoscopy
Finally, a cystoscopy (a visual examination of the bladder using a camera, conducted under anaesthetic) may be recommended to determine if cancer or another abnormality is present in the bladder.