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What are the types of haematuria?
- Haematuria is simply blood in the urine
- It is broadly classified as:
- Microscopic – not visible to the naked eye. Detected either on urine dipstick or urine microscopy
- Macroscopic – visible to the naked eye, i.e. red urine
- It can occur due to bleeding/blood loss from any part of the urinary tract
What are the causes of haematuria?
- The blood may arise from any part of the urinary tract.
- It is often classified into medical causes and surgical causes
- The most common cause of haematuria in females is urinary tract infections
- The most common cause of haematuria in males is from Benign Prostatic Hypertrophy
- The most concerning cause of haematuria in all patients is a urological malignancy/cancer – particularly bladder and kidney cancer
- Urological causes of haematuria are surgical causes and include:
- Malignancies (cancer) of the urinary tract including: kidney, ureter, bladder, prostate and urethral/penile cancers
- Urinary tract infections
- Benign Prostatic Hypertrophy
- Trauma to urinary tract
- Kidney, ureteric and bladder stones
- Radiation change to urinary tract from previous radiotherapy
- Medical causes include: glomerulonephritis (many subtypes), IgA nephropathy, Alport’s syndrome etc.
- Certain blood thinning medication increase the risk of haematuria, but there still must be a source of bleeding
What investigations are required if I have haematuria?
- All patients with blood in the urine on repeated specimens should have an evaluation
- Investigations required include:
- Urine microscopy and culture – will exclude infection and quantify the amount of blood in the urine. Some special forms of microscopy can help determine if the bleeding is from a medical or urological cause
- Blood tests – Haemoglobin to ensure no anaemia if bleeding has been heavy, kidney function baseline, clotting profile
- Urine cytology – 3 sets of urine will be collected over 3 days to check for cancerous appearing cells in the urine
- Kidney & bladder ultrasound – will help exclude a urinary tract cancer or kidney stones.
- CT Urogram/IVP – the gold standard Xray test for patients with haematuria. This CT scan with intravenous contrast looks at the kidney, ureters and bladder for causes.
- Cystoscopy – a telescopic inspection of the urethra and bladder is required to complete the evaluation in all patients.
- Ureteroscopy – in some cases, if an abnormality of the ureter or kidney is suspected, a telescopic inspection is required. For details see Urological procedures explained.
What happens if my haematuria is suspected to arise from a medical source?
- Medical causes will be suspected if:
- Microscopy suggests the red blood cells in the urine arise from the kidney tissue (glomerular red cells/casts)
- Kidney impairment exists
- There is protein in the urine
- Hypertension exists (high blood pressure)
- In these cases, you will be referred to a Nephrologists (medical kidney specialist) for an evaluation. In some cases a kidney biopsy will be required to make a diagnosis
What follow up is required if my evaluation finds no cause?
- This occurs in approximately 40% cases with microscopic haematuria and 10% cases with macroscopic haematuria
- In these cases, follow up is dictated by your risk factors for developing a urological malignancy
- Closer follow up is required in:
- Older patients – >50 years age
- Smokers – increased risk for many urological cancers
- Those with macroscopic haematuria
- Patients with lower urinary tract symptoms
- As a minimum, follow up involves a repeat urine dipstick/microscopy test in 6 months. If haematuria persist, then repeat urine cytology and kidney function blood tests are required as a minimum.
- If recurrent macroscopic haematuria occurs, a repeat evaluation is required