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Hematuria refers to the excretion of abnormal quantities of Red Blood Cells (RBCs) into the urine. Some experts believe that any amount of RBCs in the urine seen on more than one occasion is significant. Others feel that one must have at least 2-3 RBCs seen under the microscope in order to be significant. (A small percentage of the normal population will excrete greater than 3 RBCs under the microscope.) When blood is visible with the naked eye as pink or red in the urine it is called "gross hematuria". When blood is visible only under the microscope it is called "microscopic hematuria".
Evaluation
Unless there is a known cause for hematuria, it must be thoroughly evaluated. The purpose of thorough evaluation is to be certain that there is not a serious reason causing the hematuria. The routine proper evaluation for someone with hematuria includes an Intravenous Pyelogram (IVP) and cystoscopy.
An IVP is an x-ray which is done in order to evaluate the kidneys and ureters (tubes from kidneys to the bladder). It involves an injection of a special chemical called a "contrast agents" which helps visualize the urinary tract. Occasionally, a patient may be allergic to contrast and an alternative imaging method must be used.
Cystoscopy refers to the process of looking directly into the bladder optically with a scope. At times your physician may wish to put you to sleep for this procedure, but more frequently it is done while awake. Current optical technology permits the use of very small and refined instruments for this examination. Unfortunately, the only truly effective way to evaluate the bladder for hematuria is through direct vision.
If a patient has no significant protein in the urine and no evidence of poor kidney function, the evaluation of the adult may rest with an IVP and cystoscopy. The evaluation of children for hematuria is entirely different from adults and will not be discussed here.
Causes of Hematuria
The number of potential causes for hematuria are many. Happily, most of the causes do not represent serious or life threatening disease. Some of the common, less serious reasons for hematuria include kidney stones and urinary tract infections. The most common reason for hematuria in a man 50 years of age or older is benign prostate enlargement. A small percentage of the population normally has microscopic hemuturia with no apparent cause. Voiding problems, trauma, and excessive exercise ("jogger's hematuria") may also cause blood in the urine.
More serious reasons for hematuria include bladder tumors, kidney tumors, and kidney obstruction. It is reasons like these which make it necessary to properly and thoroughly evaluate all hematuria.
SOME CAUSES FOR HEMATURIA
* Kidney Stones
* Prostatic Enlargement
* Bladder Stone
* Urinary Tract Obstruction
* Urinary Tract Trauma
* Excessive exercise
* Urinary Infection
* Voiding Problems
* Sickle Cell Disease
* Kidney Tumor
* Kidney Diseases
* Bladder Tumor
Treatment
The proper treatment for hematuria is dependent upon the cause. The loss of blood in the urine rarely becomes so large that blood loss itself is a problem. This may be problematic, however, in some patients with gross hematuria. The patient with severe gross hematuria may require immediate medical attention and evaluation. Most hematuria may be evaluated and treated on a less than emergent basis.
Hematuria from a urinary tract infection should be treated with antibiotics. Blood in the urine from a stone should be treated by addressing treatment of the stone. Any known cause for blood in the urine should be treated if possible. If no reason for microscopic hematuria is found, no treatment is necessary
Summary Most hematuria is caused by non-life threatening disease. Because hematuria may at times be caused by something serious, a thorough evaluation is necessary. Treatment is tailored to the cause.
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