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Blood in Urine

Blood in urine (hematuria) at a glance

  • Blood in the urine occurs when blood cells leak into urine from some part of the urinary tract, which includes the kidneys, ureters, bladder and urethra.
  • If one sees blood in the urine, he or she should contact a doctor immediately to assess the cause.
  • Blood in the urine (also called hematuria) does not always indicate a serious condition, but warrants further investigation by a physician.

What is blood in urine (hematuria)?

Blood in the urine, also called hematuria, is due to blood cells leaking from some part(s) of the urinary tract. This includes the kidneys, the ureters (tubes that carry urine from the kidneys to the bladder), the bladder and the urethra, which carries urine out of the body.

Blood in urine may be “gross,” meaning it is visible and the urine will be pink, brownish red, tea-colored, red or cloudy. It may also be “microscopic,” visible only under a microscope—a situation that is usually discovered during a medical evaluation for some other reason or routine urine test.

Observing blood in the urine can be alarming, but it does NOT always indicate a serious condition. But because it can be a sign of a problem, a physician should always evaluate visible blood in urine. Often, treatment isn’t necessary.

Causes of blood in urine (hematuria)

Blood in urine can come from a variety of conditions as result of irritation, infection, tumor, or injury in any part of the urinary tract. Blood in the urine is itself a symptom of another condition. Some causes include:

  • Urinary tract infection or bladder infection: Bladder and urinary tract infections can cause pain or burning with urination, along with frequent urination. Infants and children may also have a fever, lose their appetite and be fussy.
  • Enlarged prostate from benign prostatic hyperplasia (BPH) or prostate cancer: Either of these conditions can cause blood in the urine because they are accompanied by an enlarged prostate. The enlarged prostate can press on the urethra, which can cause bladder irritation.
  • Kidney infections (pyelonephritis): Kidney infections are serious. Their symptoms are like urinary tract infections, but may also include chills, fever and pain in the lower back below the ribs (where the kidneys are located).
  • Kidney diseases: Kidney diseases are less common but also very serious. Symptoms of kidney disease may include high blood pressure, weakness and swelling throughout the body. Protein in the urine (proteinuria) is often present.
  • Urinary Calculi: Ureteral, kidney, and bladder stones: These are common, and their symptoms usually include severe pain in the groin, pelvis, back or abdomen.

Other causes of blood in urine may include an injury to the kidney from sports or an accident, inherited diseases such as sickle cell anemia, a tumor in the urinary tract, or certain medications.

Sometimes, pinkish urine results from eating a large amount of beets, berries or other red food or from certain medications.

Diagnosis of blood in urine (hematuria)

To understand why blood is appearing in the urine, doctors take a medical history and ask about possible reasons for the hematuria. A visible and microscopic evaluation of a urine sample may point to a cause. He or she also might order tests will check for kidney disease or other conditions.

If the physician suspects other physical abnormalities that might be causing blood to appear in the urine, he or she may order additional tests, including:

  • Imaging tests: These might include a computed tomography (CT) scan, an ultrasound scan or a magnetic resonance imaging (MRI) scan. These scans create images of the urinary tract to check for tumors, stones or abnormalities of the bladder, kidneys and urinary vessels.
  • Cystoscopy: The physician inserts a small, lighted tube with a camera through the urethra to look for any issues. A small sample of tissue may be taken (a biopsy) to check for any abnormal cells.
  • Intravenous pyelogram: (IVP) Dye is used before taking an x-ray, which can reveal structural issues of the urinary tract. This test is rarely obtained in modern practice.
  • Kidney (renal) biopsy: A physician who suspects kidney disease may request a kidney biopsy, the removal of a small sample of kidney tissue for examination beneath a microscope.

If the doctor discovers an underlying condition that is causing the hematuria, he or she will treat that cause.

Many times, a person does not need treatment for blood in urine. If serious conditions are ruled out, the physician will most likely recheck the urine later to confirm the blood has resolved or remains unchanged. The physician may suggest a follow-up check in three to six months to verify that the hematuria has not reappeared.