Seeing blood in your urine or having a doctor tell you that you have blood in your urine can be scary. Blood in your urine, also called hematuria, can be a sign of many types of health issues.
Blood in your urine always relates to a problem in your urinary tract, which includes your kidneys. Your kidneys are two bean-shaped organs that process waste from the body. Usually, the filters that are part of the kidneys block blood from entering your urine. When you have hematuria, these filters or another part of your urinary tract have leaked blood into the urine.
Types of Hematuria
There are two types of hematuria:
— Microscopic hematuria, which is blood in your urine that is only seen under the microscope. For instance, you may give a urine sample for a physical, and when analyzing the urine, your doctor finds blood.
— Gross or macroscopic hematuria, which is blood in your urine that you can see. The urine color may range from red-wine colored to red-punch colored to a faint pink, says Dr. Joseph Vassalotti, MD, chief medical officer for the National Kidney Foundation and an associate clinical professor of medicine in the division of nephrology at the Icahn School of Medicine at Mount Sinai in New York.
Anytime you can see blood in your urine, you should seek an urgent appointment from your doctor or at an emergency room. The causes for gross hematuria are sometimes serious and require quick medical attention.
Microscopic blood is not usually as urgent, but it’s still important to try to identify the cause.
Causes and Symptoms of Hematuria
Hematuria can have many potential causes that relate to your kidneys or other parts of your urinary tract. “It’s a very, very long list,” says Dr. Bradley Warady, division director for pediatric nephrology at Children’s Mercy in Kansas City, Missouri.
Potential causes of blood in the urine include:
— Bladder or kidney cancer. These types of cancer are more common in adults than children. Those over age 35 and those who smoke are at a higher risk for these types of cancers, says Dr. Brad Rovin, director of the division of nephrology at the Ohio State University Wexner Medical Center in Columbus.
— Diseases that are passed down in your family genes, such as sickle cell disease or hemophilia.
— High levels of calcium in your urine.
— Medications such as blood thinners (like warfarin) and the chemotherapy agent cyclophosphamide can cause hematuria.
— Nephritis, which is an inflammation of the kidneys.
— Trauma to the urinary tract.
The symptoms you have along with hematuria will depend on its cause. With kidney stones, you also may have pain when urinating and/or lower back pain that radiates down toward your bladder.
Symptoms of glomerulonephritis, which is a type of kidney inflammation, include fluid retention, foamy urine and high blood pressure.
With so many potential causes of hematuria, it takes detective work among health care professionals to find the cause. Your primary care doctor may refer you to a nephrologist, which is another name for a kidney specialist. Or, they may refer you to a urologist, who focuses on the urinary tract for both males and females, along with male fertility.
If you have hematuria, describe to your doctor what color the urine is. This can help them determine where the problem is starting. If the urine is cola-colored, that indicates the problem is likely from higher in the urinary tract, Warady says. This includes the kidneys.
Doctor may do several types of tests if you have hematuria. “We usually start out small and simple (with testing). Depending on what you find, along with patient history and age, it can escalate to more extensive testing,” Rovin says.
These tests can include:
— A urinalysis to analyze the urine under a microscope. Doctors will use this to measure how many red blood cells are in the urine and check for other substances,like protein. Too much protein could indicate a kidney disorder such as nephritis, while white blood cells could indicate a urinary tract infection. When seen under the microscope, the shape of the red blood cells can help guide the doctors to where in the urinary tract they are coming from, Rovin says.
— A urine culture to check for bacteria or yeast that can cause an infection.
— Blood tests that help measure kidney function. A blood test can measure for creatinine, which is a waste product. A high level of creatinine could indicate the kidneys are not working like they should. Levels greater than 1.2 milligrams per deciliter for women and 1.4 milligrams per deciliter for men can indicate early signs of a kidney issue, according to the National Kidney Foundation.
— A computed tomography urogram, which involves the injection of a dye and the use of CT technology to visualize the urinary system.
— A cystoscopy, which involves the insertion of a thin camera into your bladder and urethra to better visualize it.
— A kidney biopsy, which involves taking a tissue sample from the kidneys.
— A renal ultrasound to obtain imaging of the urinary tract. This type of imaging can help check for kidney stones or a tumor.
Treating and Preventing Hematuria
Treatment for blood in the urine is guided by the specific problem causing the hematuria. For instance, if the type of hematuria and follow-up tests indicate cancer, you will work with a health care team to find the best treatments for the cancer. For a urinary tract infection, you will be prescribed antibiotics.
If hematuria is severe and easily seen, you may have to go to the emergency room or stay at the hospital to receive intravenous fluids while doctors sort out its exact cause, Vassalotti says.
Sometimes, doctors can’t pinpoint an exact cause for hematuria. If this happens to you, let your doctor know if you have additional health changes after your initial workup for having blood in the urine, Rovin says.
Health changes may prompt the need for further testing, or your doctor may want you to return for regular follow ups to monitor the hematuria. You may just have a genetic tendency for hematuria. This is called familial idiopathic hematuria, may have no other symptoms and is not usually serious, so long as there is no family history of serious kidney disease.
There’s no way to prevent hematuria, although you can help reduce your risk of certain causes of hematuria if you know you’re prone to them. For instance, things like drinking more water and watching your diet are useful if you tend to develop kidney stones.
You can follow a few other steps to improve the health of your kidneys in general:
— Watch your blood pressure. High blood pressure affects your kidney health. If you have high blood pressure, follow any instructions from your doctor regarding medicines to use or foods to eat.
— Eat salt in moderation. A high-salt diet can raise your blood pressure. Salt levels are usually high in processed foods, so try to eat more fruits, vegetables and less processed foods.
— Get regular physical activity. People often say they are too busy for exercise, Vassalotti says. Make time for it as physical activity can help lower your blood pressure, control your weight and improve your sleep. Aim for 150 minutes of moderate, heart-pumping exercise a week, which breaks down to 30 minutes, five days a week. You could even break that down further into 10-minute brisk walks daily after each meal.
— Don’t dismiss blood in the urine. Because of its multiple causes, you should make sure to get it addressed. “It’s better to catch something early than wait to when it might be less treatable,” Rovin says.
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Update 07/05/22: This story was previously published at an earlier date and has been updated with new information.