What does blood in the urine indicate?

 

Seeing blood in the urine undoubtedly causes fear and anxiety, but the good news is that, in most cases, there is no serious problems attached to this complication. In general, the presence of blood in the urine or bloody urine is called Hematuria. In this article, we will introduce you to different types of hematuria and their main causes.

 

What does blood in the urine indicate

 

Different types of hematuria

Main reasons behind seeing blood in urine (hematuria)

 

 

Different types of hematuria

Hematuria can be visible, meaning that with the naked eye you can clearly see that your urine is bloody. In fact, a small amount of blood can change the color of your urine and make it pink or red. This type of hematuria is called visible or gross hematuria. Visible hematuria can also occur in the form of brown or cola-colored urine. The urine is dark and smoky in these cases, and sometimes the patient notices a clot in his or her urine.

On the other hand, sometimes you cannot see the blood in your urine with the naked eye, and it is only the observation of urine under a microscope that proves the presence of red blood cells in the urine. As you may guess, this type of hematuria is called microscopic hematuria. The incidence of microscopic hematuria is much higher than visible or gross hematuria.

Note that bloody urine or hematuria is not usually accompanied by pain or discomfort.

What does blood in the urine indicate

 

Different causes of hematuria

  • Pyelonephritis or kidney infections

  • Stones in urinary tract

  • Kidney diseases

  • Heavy exercise

  • Cancers

  • Medicines

  • Rare causes of hematuria

 

Pyelonephritis or kidney infections:

Occurs when infectious bacteria enter kidneys through the bloodstream. When kidneys become infected, usually they initiate some symptoms and problems. Among all symptoms, some are related to bladder and urinary tract annoyance during infectious particle excretion from kidneys.

Urgent need for urination, back pain, fever, and needle-like sharp pain during urination are some of the other symptoms commonly seen in patients suffering from kidney infections.

If you have fever or do not feel well beside your bloody urine, call your medical adviser as soon as possible.

Stones in urinary tract:

Minerals in the urine may precipitate and form crystals in the kidneys or bladder specially if the urine concentration increases.

As the crystals join together, urinary stones form. The small stones may pass easily through the urinary tract with almost no problems or treatment. However, they may result in microscopic or invisible blood in the urine.

On the other hand, larger stones that block the urinary tract will cause pain in addition to hematuria and may need excessive medical interventions or surgery to be removed.

Urinary tract stones considered one of the most common causes of seeing blood in the urine. This is why your physician may request some sort of imaging, like sonography, to examine urinary tract for any kind of stones after seeing blood in your urine. Fortunately, modern imaging tools and techniques can detect stones as small as two millimeters.

Kidney disease:

The cluster of capillaries responsible for kidneys’ main job, i.e. filtering blood from waste products, is called Glomerulus. The inflammation of these small blood vessels, either caused by any disease or medication, like the drugs used for urinary tract’s treatments, is called Glomerulonephritis. In almost every type of glomerulonephritis, the presence of blood in the urine is quite common. There are many types of glomerulonephritis, where the most common ones are:

  • Glomerulonephritis after a sore throat caused by bacteria or bacterial pharyngitis

  • Diabetes

  • IgA nephropathy or Glomerulonephritis IgA which is a disease in which the kidney loses its ability to filter urine thoroughly due to the presence of abnormal increase of an antibody (a protein that body builds to fight against bacteria or foreign microorganisms).

  • Lupus

  • And a long list of medications which can cause glomerulonephritis which is beyond the scope of this article.

Heavy exercise:

For unknown reasons, professional runners and other athletes who engage in continuous physical activities experience hematuria after strenuous exercise or competition. This condition will resolve spontaneously after stopping the activity without any permanent damage to kidneys.

Cancers:

The presence of visible and/or invisible blood in the urine can also be a sign of a malignancy or cancer. Kidney and bladder cancers or advanced prostate cancer can be accompanied by hematuria.

Urinary tract cancers mostly cause microscopic or invisible hematuria. But among all the causes of visible or gross hematuria, urinary tract cancers are one of the most common ones.

In other word, the probability of having cancer with gross hematuria is much higher than having cancer when the blood in invisible in the urine.

Medicines:

There are some medications that have blood in the urine or hematuria as their side effects such as:

  • Penicillin

  • Cyclophosphamide (Cytoxan)

  • Sulfonamides (including: Sulfacetamide and sulfamethoxazole)

  • Rifampin

  • Phenytoin

Bloody urine has been also seen in some people taking aspirin, heparin, and other anticoagulants.

Benign enlargement of the prostate

In this condition also known as benign prostatic hyperplasia (BPH), there is some sort of pressure in the passage of urine that is believed to be causing microscopic hematuria. For more information, you can refer to the BPH article.

Kidney injury trauma

outside forces can injure the kidneys which may lead into hematuria

Other rare causes of hematuria

Some rare cases that may be accompanied by the presence of blood in the urine include:

  • Hereditary diseases (an inherited kidney disease that affects the small arteries of the kidneys) such as Alport syndrome.

  • Schistosoma parasite, which often infects the bladder.

  • Infection and inflammation of the prostate (prostatitis).

  • Any manipulation of the urethra, such as a urinary catheterization or cystoscopy (a tube-shaped device called a cystoscope or urinary catheter that enters the bladder through the urethra so that the doctor can see inside the bladder and its walls)

  • Red blood cell ruptures and destruction like what happens in person with Favism or G6PD (glucose-6-phosphate-dehydrogenase deficiency).

  • Paroxysmal nocturnal hemoglobinuria: A rare and dangerous blood disease that affects red blood cells and force them to break apart.

  • Ureteropelvic junction obstruction (UPJO)

  • Nutcracker syndrome which is a rare vein compression disorder in which arteries squeeze the left renal (kidney) vein. To be more precise, it is a disease caused by compression of the renal artery between the abdominal aorta and the upper anterior artery

  • Loin pain hematuria: this disease is a combination of unilateral or bilateral pain with hematuria

  • Allergies (especially in children)

  • Sickle cell anemia: disorders that occur in the structure of red blood cells and are sometimes associated with hematuria

 

The final word

It should be noted that in smokers and old people, the presence of blood in the urine can be the indication of bladder cancers. Although it is true that in most of the cases where there is a blood in the urine, the reason is not a serious disease, but the patient is strongly advised to see his or her doctor ASAP.

If hematuria is accompanied with any of the following symptoms, you should take it very seriously:

  • Chills

  • Recent weight loss

  • Fever

  • Happened in a frequently smoking patient

  • Diabetes mellitus

 

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