What are the types of haematuria?
Haematuria is simply blood in the urine and can originate from any part of the urinary tract
• Microscopic – not visible to the naked eye (detected on a dipstick or urine test)
• Macroscopic – visible to the naked eye (urine is stained red with or without clots)
What are the causes of haematuria?
• Urinary tract infections (most common cause in females)
• Benign prostatic hyperplasia (BPH)
• Kidney stones
• Cancer – kidney, ureter, bladder, prostate, urethra
• Previous radiotherapy (radiation cystitis)
• Medical causes (eg. glomerulonephritis) – require referral to renal specialist
Note - blood thinning medications increase the risk and amount of haematuria, but the source of bleeding should always be investigated.
What are the investigations for haematuria?
In order to rule out sinister causes, all patients with blood in the urine should have a thorough evaluation including:
• Blood test – to check kidney function
• Urine test – to rule out infection
• Urine cytologies test – 3 samples to check for cancerous cells in the urine
• Imaging - Kidney and bladder ultrasound – to look for cancers and stones
CT IVP (gold standard) – more accurate for looking at the kidneys and ureters
• Cystoscopy – telescope inserted via the urethra (water pipe) to directly visualise the bladder
• Ureteroscopy/pyeloscopy – if an abnormality of the ureter or kidney is suspected, direct visualisation of these is required via the bladder.
What if my evaluation finds no urological cause?
• This occurs in approximately 40% cases with microscopic haematuria and 10% cases with macroscopic haematuria
• Closer follow up is required in: older patients (>50 years old), smokers, those with macroscopic haematuria and other lower urinary tract symptoms This involves repeating urine tests in 6 months.
• With recurrent macroscopic haematuria, a full repeat evaluation may be required
• If a medical cause is suspected you will require a referral to a renal physician (kidney specialist) for further assessment