| Subject | Contents |
| Definition | The presence of blood in the urine. |
| Alternative Names | Hematuria; Blood in the urine |
| Considerations | Blood in the urine should never be ignored! Blood in the urine is usually caused by kidney and urinary tract diseases. However, there are a couple of exceptions: In women, the blood may appear to be in the urine when it's actually coming from the vagina . In men, the urethra carries both urine and semen out of the body and what may be mistaken for urinary bleeding is sometimes a bloody ejaculation usually due to a prostate problem. In children, coagulation disorders (such as hemophilia ) or other hematologic problems such as sickle cell disease , renal vein thrombosis , or the thrombocytopenias can be underlying reasons for newly discovered blood in the urine. Bladder infections are more common in women than in men, and they are especially common during pregnancy . Bladder infections are usually accompanied by pain or burning on urination , frequent urgent urination, and occasionally blood in the urine. In young children, fever may be the only sign of a urinary tract infection. Kidney disease following strep throat is a classic cause of blood in the urine in children. Microscopic blood is found on routine screening urinalysis in up to 2% of children. If it remains present on 3 samples with no obvious cause, a step-by-step outpatient evaluation may be undertaken to determine the source. When blood in the urine is visible to the naked eye, children must be evaluated thoroughly and promptly because of the strong possibility of significant hypertension or kidney disease. Children are often hospitalized for this evaluation. Discoloration from drugs or foods can mimic blood in the urine. |
| Common Causes | Kidney stoneBladder stones that lodge in the urethra Benign familial hematuria Chronic or recurrent urinary tract infectionCystitisPyelonephritisUrethritisIgA nephropathySickle cell diseaseCoagulation disorders (including hemophilia ) ThrombocytopeniaRenal Vein thrombosisSystemic lupus erythematosisHemolytic-uremic syndromeAnaphylactoid (Henoch-Schonlein) purpuraPolycystic kidney disease Congenital anomalies of the urinary tract or blood vessels Tumors of the urinary tract Glomerulonephritis Bladder tumor Kidney tumor Enlarged and infected prostate (prostatitis) Post-streptococcal GN Urethral ulceration Hypercalciuria (increased amounts of calcium in the urine) Distal renal tubular acidosis Use of diuretics, "water pills" HyperparathyroidismHypothyroidismHypercalcemiaHypertensionJuvenile rheumatoid arthritisMedullary cystic diseaseMetabolic acidosisNeoplasmSarcoidosisAcute tubular necrosis "Hardening" of the urinary opening (meatal stenosis) Trauma Fracture of the pelvis Renal contusion (bruised kidney) Renal fracture ("broken" or torn kidney) Urethral trauma Surgical procedures, including catheterization, circumcision, surgery, and renal biopsy Drugs Anticoagulants Cyclophosphamide Metyrosine Oxyphenbutazone Phenylbutazone Thiabendazole |
| Home Care | Follow prescribed therapy to treat the underlying cause. Drink lots of fluids, unless it is difficult to breathe, or unless the ankles are swollen. Cranberry juice might also be effective, but the evidence is conflicting. |
| Call your health care provider if | There is blood in the urine. This should never be ignored! Bleeding recurs. Passing blood clots. Unable to urinate. |
| What to expect at your health care provider's office | The medical history will be obtained and a physical examination performed. Medical history questions documenting dark or bloody urine in detail may include: Time pattern When did the urine become dark or bloody? Did it occur suddenly? Quality What color is the urine? Is there any pain associated with urination? Is it consistently the same color throughout the day? Is the quantity of urine per day decreased or increased? Is any blood visible? Is there an odor? Aggravating factors Are medications being used that could cause this change in color? Have foods been eaten that could cause this change in color (such as colored candy, beets, berries, rhubarb)? Relieving factors Does a change in diet change the color of the urine? Does a change in medication change the color of the urine? (Note: NEVER change medications without first consulting your health care provider.) Other What other symptoms are also present? Is there pain when urinating ? Is there pain in the abdomen ? Is there back pain ? Is there a fever ? Has there been a decreased fluid intake or decreased thirst ? Has there been a decreased appetite ? Is there nausea , vomiting , or diarrhea ? What medications are being taken? Have you had previous urinary problems or kidney problems? Do you have any allergies ? Have you had previous similar symptoms? Has there been a recent injury? Has there been any recent diagnostic or surgical procedures involving the urinary tract? Has there been a change in sexual activities? A physical examination will be performed, and vital signs (temperature, pulse , rate of breathing, blood pressure ) may be monitored. With a pre-existing kidney infection , a more detailed history and physical are needed. Extra laboratory studies may be necessary. In women with a discharge, an examination of the vagina and any discharge is usually necessary. Diagnostic tests that may be performed include: Blood studies such as a CBC , blood differential , C3 , and creatinineUrinalysis Urine culture 24-hr urine collection for creatinine, protein, calcium Tests for strep Tests for lupus Tests for sickle cell, bleeding problems, and other blood disorders. CystoscopyKidney biopsyX-rays of the kidneysIVPAbdominal ultrasoundCT scan of the abdomen Treatment The treatment will depend on the cause of the blood in the urine. If urinary tract infection is confirmed, antibiotics may be prescribed. If appropriate, pain medications will be administered. After seeing your health care provider, you may want to add a diagnosis related to bloody or dark urine to your personal medical record. |
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