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Blood in urine (hematuria)

Definition


Disease: Blood in urine (hematuria) Blood in urine (hematuria)
Category: Genito-urinary diseases

Disease Definition:

Hematuria is the condition in which there's blood in the urine. This condition isn't always serious, despite the fact that it may make a person anxious.
Arduous exercising might be one of the causes of this condition, and so can a number of common drugs, including aspirin. However, urinary bleeding could sometimes be a serious disorder.

The two kinds of hematuria are:

Gross Hematuria:

In this type, the blood is visible in the urine.

Microscopic Hematuria:

In this type, the blood is only visible in a microscopic test, mainly found when the patient is having their urine tested for other reasons.

In either case, it’s better to know the reason behind such disorder. As such, the treatment is dependent on the condition and the underlying cause of the blood in urine. Most of the time this condition is due to excessive exercising, in which case the blood goes away in a day or two. Medical care will probably be required if the cause of this condition is something else.
 

Work Group:


Symptoms, Causes

Symptoms:

Pink, red or cola colored urine (the existence of red blood cells in urine) is the only visible sign of hematuria. Very limited amount of blood is enough to produce red urine, the bleeding is usually not painful, and often no other symptoms accompany this disorder.
In many other cases, a person may have blood in their urine that is only visible under a microscope (microscopic hematuria).
 

Causes:

The urinary system is comprised of the two kidneys, ureters, bladder, and urethra. The kidneys’ job is to discharge extra fluid and wastes from the blood and change it to urine. Urine flows via two hollow tubes called ureters, one from each kidney, to the bladder, where urine is kept until it passes through the urethra and out of the body.

In case of hematuria, the kidneys or other parts of the urinary system allow leakage of blood cells into the urine.  A number of problems can cause this leakage including:

Urinary tract infections:

Women are more apt to have urinary tract infection than men. It happens when a kind of bacteria enters the body through the urethra and begins to breed in the bladder. The infection might, but not always, develop after sexual activity. Some of its symptoms could be:

 

  • A very foul-smelling urine
  • A persistent urge to urinate
  • Pain and burning sensation with urination


For some people, especially older adults, the only sign of illness might be microscopic blood. About 30% of people with urinary tract infection have visible bloody urine.

Other urinary tract infections:

When bacteria invade someone's kidneys from their bloodstream, or if they climb up from the ureters, kidney infections may occur, which are also called pyelonephritis.
Other than fever and flank pain, the signs and symptoms of this condition are usually similar to bladder infections.

Kidney disease:

The kidneys' filtering system could be infected, causing microscopic urinary bleeding, which is a common symptom of glomerulonephritis. Glomerulonephritis may occur on its own, or it may be part of a systemic disease, such as diabetes. This condition may also be caused by immune system problems, for instance IgA nephropathy which affects the small capillaries filtering blood in the kidneys (glomeruli); by viral or strep infections; or vasculitis, which is a blood vessel disease.

A bladder or kidney stone:

In concentrated urine, minerals settle down, creating crystals on the walls of the kidneys or bladder. By time, the crystals develop to hard small stones like sand grains. Those stones are pain free and the person won't notice that he/she has kidney or bladder stones unless they block urination or are passed out. In this case, kidney stones can lead to both gross and microscopic bleeding and cause excruciating pain.

Enlarged prostate:

It is one of the main reasons behind visible bloody urine in men older than 50. The prostate gland, which is an organ located just below the bladder surrounding the top part of the urethra, begins to grow in size as men draw to middle age. When the gland enlarges, it presses on the urethra, stopping urine flow. Prostatitis, which is the infection of the prostate, and an enlarged prostate,  which is also called benign prostatic hypertrophy or BPH, cause the same signs and symptoms, such as: 

 

  • Gross or microscopic bleeding
  • Difficulty urinating
  • An urgent or frequent need to urinate

 

Kidney injury:

Visible blood in the urine may be caused by an accident or contact sports, in which there's a blow or other injury to the kidneys.

Cancer:

Advanced kidney, bladder or prostate cancer show visible urinary bleeding as a first sign. Unluckily, in the early stages of the disease, when it is still treatable, it usually doesn't show any signs or symptoms.

Inherited disorders:

Gross and microscopic hematuria could be the result of sickle cell anemia — a chronic shortage of red blood cells— and/or Alport syndrome which affects the filtering membranes in the glomeruli of the kidneys.

Strenuous exercise:

It’s still unclear why exercise could cause gross hematuria but it could be attributed to a trauma to the bladder, dehydration or the breakdown of red blood cells that occurs with sustained aerobic exercise. Almost any athlete can have visible urinary bleeding after a dense workout but runners are most often affected.

Medications:

Acetylsalicylic acid, penicillin, the blood thinners warfarin and heparin, and the anti-cancer drug cyclophosphamide  are all common drugs that can cause visible urinary blood.
 

Complications

Complications:

None

Treatments:

Hematuria has no one treatment method. The doctor needs to look for the main causes of the condition:

Enlarged prostate:

Reducing symptoms and restoring normal functioning of the urinary tract are some of the main treatments for enlarged prostate. All of these treatments have limits to their effectiveness and all have drawbacks. Because medications provide long-term relief to many men, they will be used as the first line of treatment. If they don’t work out well, minimal invasive treatments using heat, laser or sound waves could be used to break down excess prostate tissue.

Urinary tract infection:

Here, antibiotics are used to treat the urinary tract infection.  After few days of taking medication, the signs begin to retreat, but recurrent infection needs longer or multiple therapy.

Cancer:

There are number of treatments for kidney and bladder cancer, but surgery to remove cancerous tissue is mostly the first choice, simply because the cells relatively resist radiation and most types of chemotherapy. In bladder cancer, resection or complete removal of the bladder might be the first solution. In other cases, chemotherapy is joined with surgery. In milder cases, medications are used to boost the immune system.

Kidney stones:      

Drinking large amounts of water and keeping active could help in passing out the stone. I this case, the doctor will tell the patient the exact amount of liquid needed. Invasive measures are used if the assigned amount of liquid doesn’t work. These include shock waves to break the stone into small pieces, also called extracorporeal shock wave lithotripsy; and in some cases, surgery to remove the stone.

Inherited disorders:

Here, treatments vary a lot. Usually, benign familial hematuria doesn't require treatment whereas people with severe Alport syndrome may eventually need dialysis, which is an artificial way of getting rid of waste products from the blood when the kidneys are inefficient to do so. Medications, blood transfusions, or a bone marrow transplant are used to treat sickle cell anemia.

Kidney disease:

All kidney diseases need treatment no matter what the underlying reason. Limiting further damage to the kidneys and relieving inflammation are the major two goals of treatment.
 

Prognosis:

Not available

Expert's opinion

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