Hematuria is a scientific term for blood in the urine. As can be imagined, this is an alarming condition for the patient. The causes of this condition are many.

The most common conditions are:

• Infections in the urinary tract:
Infections can arise from kidneys, ureter, urinary bladder, prostate, or urethra. Out of these the most common infections causing hematuria is the urinary bladder in both sexes and prostate in the male. In females, urinary bladder infections-also termed cystitis-are very common. Many patients with cystitis present with blood in the urine. In males, enlargement of the prostate with bleeding is a common cause and occurs in old age. Surprisingly cancer of the prostate is not as common a cause for hematuria as benign enlargement of the prostate. The infection of the kidney is a rare cause of hematuria.

• Stone disease:
Stones in kidney, ureter, and urinary bladder can cause bleeding. This bleeding can be intermittent and could be associated with pain and irritative urinary symptoms.

• Cancers:
Cancers of the urinary tract can arise from any of the urogenital organs. Of these, cancers of the kidney, ureter, urinary bladder, prostate, and urethra are the sources of hematuria. Such hematuria occurs in the older population and many times is the only symptom of cancer. This leads to a delay in diagnosis because the bleeding may not be continuous and the patient ignores bleeding as it stops on its own.

• Glomerulonephritis:
This term refers to a group of diseases affecting the small blood vessels of the kidneys. Many of them lead to haematuria. Apart from hematuria, the patient may present with hypertension, foamy urine, and swelling in the face and feet. The hematuria can be macroscopic (that which can be seen by the naked eye) or microscopic (that which cannot be seen by the naked eye, but can be detected by microscope). These diseases are treated by nephrologists.

• Cystic diseases of the kidney:
Some people suffer from a condition where the kidneys have cysts which are fluid filled cavities. This disease can be either acquired or inherited. Such patients may present with haematuria.

• March hematuria:
This is an interesting cause of blood in the urine. This refers to hematuria resulting from any strenuous activities like jogging, marching, running, etc. This is more commonly seen in endurance running and those who indulge in heavy weight bearing exercises. Usually, it subsides once the exercise is stopped and doesn’t need any special treatment.

• Coagulation disorders:
Any condition which affects either the clotting of blood or prolongs bleeding time can result in hematuria. These disorders are not common but can be life-threatening in severe cases. Examples include haemophilia, platelet disorders, protein disorders, etc. A common platelet disorder that we see more commonly is in dengue fever where there is a decrease in the platelet numbers resulting in bleeding from various body organs. These have to be treated on an emergency basis after admitting to a hospital.

The list of causes enumerated above is only a listing of more common causes. There are many more causes of hematuria.

Tests
Once a patient complains of blood in the urine, the doctor will have to ascertain that the red coloured urine is actually blood in the urine. The reason is there are many situations where the urine is red colored. For example, excess eating of beetroots or blueberries can result in alarming red colored urine but is a harmless condition. This can be easily found out by a urine test which will detect if there are red blood cells in the urine or not.

Urine culture and sensitivity: This will detect if there is a urine infection resulting in hematuria.
Blood tests: There are a series of tests that will detect causes for hematuria. They can range from very simple tests to more complicated tests depending upon the diagnoses.
Ultrasound abdomen: This is a commonly done and very useful test that will detect the cause in a very large number of hematurias. Stones, infections, cancers, and many other conditions can be easily detected by this test.

CT scan with angiogram: This is a specialized test that is done when despite basic tests, the cause is not found. It is a very sensitive test that will detect abnormalities of blood vessels etc
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Treatment

The treatment of hematuria depends upon the cause.
• Infections are treated with antibiotics.
• Stones, cancers, cysts, etc. are treated appropriately by a urologist.
• Glomerulonephritis is treated by drugs by nephrologists.

Outcomes

The fear every patient will have is what will happen to my life or kidneys. The answer depends upon the cause for the bleeding. The good news is that a large majority of diseases causing hematuria are mild, non-serious, and easily treatable. Rarely some of the diseases are serious and even life-threatening but they are small in numbers.

In India, many people think blood in urine is due to ‘heat’ and ignore it. In medical parlance, there is no entity called ‘heat’! Almost always, there are known causes of hematuria which have to be detected and treated.

Therefore the message is this: Don’t ignore hematuria!

To know more, visit: www.nelivigimultispecialityhospital.com