Hematuria

Symptoms

Most often blood in the urine is the single most common symptom and sign of hematuria.

The patient is thoroughly evaluated for symptoms and this may give an insight into the underlying reason for hematuria –

• Abdominal pain in the flank - maybe indicative of a small stone in the kidney or ureter.

• Decreased urinary force/incomplete urination is indicative of tumor or benign prostate hyperplasia (BPH).

• Fever with flank pain could indicate kidney infection.

• Pain in the side or flank maybe a sign of kidney tumor.

• Urinary frequency (polyuria) pain (dysuria) or urgency in urination can be a symptom of bladder infection or sometimes even cancer.

Diagnosis – Patient History

Diagnosis is often initiated by recording the patient’s family and medical history. The information sought would be associated with the following -

• History of kidney stones

• Smoking/drinking habits

• Drug usage

• Infections/injuries/recent illnesses/sore throat

• Urinary habits/anything unusual like clots or stone during urination.

• The phase of urination during which the red color appears.

• History of/Exposure to Sexually transmitted disease (STD)

• Exposure to toxins.

Taking the family history of the patient may give clues to any inherited genetic conditions that are associated with hematuria such as sickle cell anemia, von Hippel-Lindau disease or a inherited predisposition to kidney stone disease.

A complete physical exam is carried out with special focus on the abdomen, urinary tract, pelvis, genitals and rectum.According to the American Urologic Association (AUA) guidelines , the presence of greater than 3 red blood cells per high powered field amounts to significant microhematuria in high risk patients and it demands the following tests to be carried out -

1) Upper tract imaging accomplished by a CT urogram remains the gold standard.

2) Urine cytology - examination of the urine to study the various cells and rule out cancer.

3) Cystoscopy - to study the inside of the bladder in detail in order to detect tumors or stones.

In older patients cytoscopy is often carried out. Blood tests, ultrasound, X-rays, Intravenous pyelogram (IVP) and CT Scan, are some of the effective diagnostic methods employed.