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Haematuria

Condition Overview:

Haematuria means the appearance of blood in the urine. Haematuria is most commonly present in very small quantities (microscopic haematuria) and is only detected by a simple dipstick test. Less often visible blood may appear in the urine as a brown discolouration or red.

Blood should not normally appear in the urine, red blood cells are kept in the blood stream by the filtering units of the blood, the glomeruli. Any part of the urinary tract from the kidneys to the bladder and urethra may be a cause of haematuria.

Haematuria is more common when taking medication to thin the blood ( eg Warfarin). However it is still possible that a separate problem may be causing the haematuria and other tests are still needed. Haematuria may sometimes be found in sickle cell anaemia (or even sickle cell trait).

Haematuria may not be a important, if any of the following can explain it:

•  Haematuria can be detected in the urine during a menstrual period.
• When it occurs only during a urine infection.
• Sometimes some medicines and foods can colour the urine red. This is not the same as passing blood.
• When it only occurs following strenuous exercise.

Blood tests are done to check for a low blood count (anaemia) and that the kidney is working normally. The urine will be checked for protein and for infection.
An ultrasound scan looks at the kidneys for cysts or tumours. Sometimes, an X-Ray with a dye injection (IVU or IVP) is done.
A special test called a cystoscopy is often needed. This test uses a camera at the end of a flexible tube to examine the bladder wall. It is possible to do this test under local anaesthetic.
If after all these tests it seems that the bleeding is coming from the kidney, then a kidney biopsy may be suggested. This test involves taking a very small piece of kidney tissue and examining it under the microscope. Things that suggest that diseases of the kidney may be the cause of the bleeding include:

Sometimes no definite cause for the bleeding is found. Usually this means that the risk of there being a serious cause for the bleeding is very low. Where there are no signs of serious disease, occasional (every 6-24 months) monitoring of the urine, blood tests and blood pressure is usually all that is required. This is to detect the rare cases where the haematuria is an early sign of an important condition that develops later in life.