Blood in the urine, called hematuria, should never be ignored, even if it happens only once or causes no pain. It can come from the kidneys or anywhere along the urinary tract, and finding the cause is important. Dr. Satarupa Deb evaluates hematuria at Bombay Hospital, South Mumbai.
What Is Hematuria?
Hematuria means the presence of red blood cells in the urine. In gross (visible) hematuria, the urine looks pink, red or cola-coloured. In microscopic hematuria, the urine looks normal and the blood is detected only on a urine test.
Blood may arise from the kidney filters (glomeruli), the kidney tissue, the ureters, the bladder, the prostate or the urethra. Nephrologists focus mainly on causes within the kidney, while urologists evaluate the lower urinary tract, and the two often work together.
Because hematuria can come and go, a single normal test does not always rule out a problem. Your doctor may ask you to repeat the urine test on a few occasions, avoiding the days around menstruation or heavy exercise, to get an accurate picture.
Possible Causes
Some causes are harmless and temporary, while others need treatment. Common causes include:
- Urinary tract or kidney infections
- Kidney or bladder stones
- Glomerular diseases such as IgA nephropathy
- Polycystic kidney disease and other inherited conditions
- An enlarged prostate in men
- Vigorous exercise, recent injury or menstrual contamination
- Blood-thinning medicines, though these usually unmask another cause
- Tumours of the kidney or bladder, particularly in older adults and smokers
Associated Symptoms
Hematuria may occur on its own, or with other symptoms that point towards the cause:
- Burning or pain while passing urine, suggesting infection
- Severe side or back pain, suggesting a stone
- Frothy urine, swelling or high blood pressure, suggesting kidney disease
- Fever, chills or passing clots
How Hematuria Is Investigated
A careful history and examination guide testing. Your doctor may first repeat the urine test to confirm true hematuria.
- Urine microscopy to look at the shape of red cells and for casts
- Urine culture to check for infection
- Urine protein measurement and blood creatinine
- Ultrasound of the kidneys and bladder, or a CT scan where needed
- Cystoscopy by a urologist in selected patients
- Kidney biopsy when a glomerular disease is suspected
Treatment
Treatment depends entirely on the cause. Infections are treated with appropriate antibiotics, and stones may be managed with fluids, medicines or procedures. Glomerular diseases may need blood pressure control, medicines to reduce protein leakage and, in some cases, medicines that calm the immune system.
When no cause is found and kidney function, blood pressure and urine protein are normal, your doctor may recommend periodic monitoring rather than treatment.
When to See a Nephrologist
See a doctor promptly for any visible blood in the urine. A nephrologist review is advisable if microscopic hematuria persists, especially when accompanied by protein in the urine, high blood pressure, swelling or reduced kidney function.
Frequently Asked Questions
Is blood in the urine always serious?
Not always. It may be due to exercise, infection or menstruation. However, since it can also signal kidney disease, stones or tumours, it should always be evaluated by a doctor.
Can certain foods make urine look red?
Yes. Beetroot, some berries, food colours and certain medicines can colour urine red or orange without any blood. A urine test can confirm whether blood is truly present.
What is the difference between a nephrologist and a urologist for hematuria?
A nephrologist treats medical kidney conditions such as glomerular disease, while a urologist handles surgical conditions such as stones and tumours of the urinary tract. Depending on your tests, you may need one or both.
Why might I need a kidney biopsy?
A biopsy may be advised if hematuria comes with protein in the urine, rising creatinine or high blood pressure, since it can identify the exact type of glomerular disease and guide treatment.
Consult Dr. Satarupa Deb
If blood has been found in your urine, book a consultation with Dr. Satarupa Deb at Bombay Hospital, South Mumbai, for a careful, step-by-step evaluation.
This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.