The medical term for blood in the urine is hematuria. When the patient can see the blood in the urine, it is referred to as gross hematuria. In other instances, the blood may only be seen on microscopic examination of the urine. This is referred to as microhematuria. Regardless of the setting, hematuria is never normal and should be evaluated by an urologist without delay.

Common causes for hematuria include kidney stones, prostate enlargement, infection, trauma and the use of blood thinners such as Coumadin (warfarin) or Plavix. Kidney disease related to high blood pressure or diabetes can result in hematuria. More serious causes include bladder or kidney cancer. When a patient has hematuria, there is no way to know if the cause is serious without a complete evaluation of the urinary tract.

The upper urinary tract is best evaluated with a CT scan or an IVP. A sonogram can also be obtained in some cases, but does not give as much information as a CT or IVP. If any abnormalities are seen on these tests, a small scope may have to be passed into the upper urinary tract for further evaluation.

Patients with hematuria must have the lower urinary tract (bladder) evaluated with cystoscopy. Cystoscopy is a simple, short procedure that is performed in the urology office. A small scope is passed through the urethra to observe the bladder lining and the opening to the kidneys.

Fortunately, in 20-30 percent of cases, the above tests are normal and no identifiable cause is found for hematuria. This is good. And in these cases, no further testing is required. On these occasions, the hematuria will usually resolve as mysteriously as it appears. If it persists beyond 2 years, a repeat evaluation by an urologist is usually recommended.
Blood in the Urine
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Steven A. Johnson, M.D.