Have you noticed that your urine appeared red, or did a routine health check reveal blood in your urine? Hematuria can be alarming, and many people immediately seek medical advice when they encounter it. The cause of hematuria is crucial as it can range from mild conditions to more serious health concerns. Today, let’s explore hematuria in-depth and focus on common and serious causes, emphasizing those that should not be overlooked.
What is Hematuria? It Can Be Visible or Only Detected Under a Microscope
Hematuria refers to the presence of red blood cells in the urine. It can be visible to the naked eye or only detectable through a microscope.
- Gross Hematuria is when blood is visible in the urine, making it appear red or pink.
- Microscopic Hematuria occurs when blood is not visible, but red blood cells are detected under a microscope.
Studies show that 14.7% to 27.8% of patients with gross hematuria have urinary tract tumors, while 2% to 11% of patients with microscopic hematuria are diagnosed with malignant tumors.
Red Urine – Causes and When to Worry
If your urine appears red, it’s essential to determine whether it’s genuine hematuria or another cause. Aside from blood, urine can appear red due to various other reasons. Let’s differentiate between the two:
- True Hematuria: When at least 3 red blood cells are found in urine after microscopic examination. True hematuria can result from urinary tract infections (UTIs), kidney stones, tumors, glomerular disease, trauma, and more. Causes vary by age, gender, and symptoms.
- False Hematuria: In this case, urine may appear red to the naked eye, but a microscopic examination shows no blood. This can happen due to foods like beets, food coloring, or certain medications such as rifampin (used for tuberculosis treatment).
How to Differentiate Between True and False Hematuria:
Microscopic examination is key. If blood is detected, further tests are necessary to determine the underlying cause.
Other Causes of Red Urine:
- Myoglobinuria: If muscle tissue breaks down due to intense exercise or trauma, myoglobin (a protein) can leak into the urine, making it appear red. This condition is called rhabdomyolysis, and can cause serious complications if not addressed promptly.
- Hemoglobinuria: This occurs when hemoglobin from destroyed red blood cells appears in the urine, often caused by severe hemolysis, burns, crushing injuries, or diseases like hemolytic uremic syndrome (HUS).
- Temporary Hematuria: Blood in the urine can also be temporary, caused by menstruation, viral infections, allergic reactions, intense physical activity, trauma, or sexual intercourse. In these cases, repeat urine tests can confirm that the blood has cleared without further intervention.
When to Be Concerned About Hematuria
- Persistent Hematuria: If red blood cells are found in at least two of three urine tests, further investigation is needed.
- Severe Hematuria: If 100 or more red blood cells are found in a single urine test, or if visible blood is present, it’s crucial to undergo further evaluation.
- In Older Adults: Hematuria in people over 50, especially those with a smoking history, requires careful examination for urinary tract cancers. Bladder cancer, for example, is the most common cause of hematuria in older individuals.
Accompanying Symptoms and Their Implications
The presence of other symptoms along with hematuria can help identify its cause:
- Pain: The presence of pain is an important diagnostic clue. Pain often indicates kidney stones or a urinary tract infection (UTI).
- In men, back or flank pain, abdominal pain, or pain in the groin could indicate kidney stones. If red urine is present, kidney stones should be suspected, and diagnostic imaging like X-rays or CT scans are recommended.
- In women, if there are symptoms like frequent urination, urgency, and pain in the bladder area, bladder infections (cystitis) should be considered.
- Proteinuria (Protein in Urine): When hematuria is accompanied by proteinuria, glomerular diseases or kidney conditions such as IgA nephropathy may be suspected. Conditions with high blood pressure and edema should also be considered.
Age-Related Causes of Hematuria
Age plays a significant role in determining the cause of hematuria:
- Under 30: In younger adults, inflammatory diseases and urinary stones are more common. Symptoms, such as pain, usually accompany these conditions, but sometimes hematuria may appear without symptoms.
- Over 35: As individuals age, the risk of malignant diseases like urinary tract cancers (bladder cancer) increases. Bladder cancer is responsible for 80-90% of hematuria cases in older adults. Smoking significantly increases the risk of these cancers, making screening critical in older smokers.
Next Steps: What to Do If You Have Hematuria
- Detailed Medical History: A doctor will ask detailed questions to help identify the potential cause. Important factors include pain during urination, recent heavy exercise, fever, and menstruation history. For individuals with a family history of kidney diseases, conditions like polycystic kidney disease or hereditary hematuria might also be considered.
- Follow-Up Testing: If hematuria persists, additional tests will be conducted, including urine tests for protein and white blood cells. A CT scan or cystoscopy may be recommended to rule out cancer, especially in older adults.
- Tracking Hematuria: If the underlying cause remains unclear after tests, doctors may recommend follow-up examinations every 3-6 months for up to 3 years, especially for older patients, to monitor potential developments.
Conclusion
Hematuria can be a sign of various underlying conditions, ranging from mild to serious. It’s important to determine whether the blood in the urine is temporary or caused by a pathological condition. Age, symptoms, comorbidities, gender, and family history all play a role in identifying the cause. Whether it’s a urinary infection or a malignancy, if you notice blood in your urine, it’s essential to seek medical attention for accurate diagnosis and treatment.