Hematuria is the presence of blood in the urine. This bleeding can range from being visible to the naked eye (gross hematuria) to only detectable by urinalysis and through microscopic analysis (microscopic hematuria). There are many causes for hematuria, some serious and some inconsequential. In some patients, no cause is identified for their hematuria; however, it is important that any patient determined to have hematuria have an appropriate evaluation with a urologist.
The first step in evaluating hematuria is a medical history and physical examination. A urinalysis is done to examine for protein (a sign of kidney disease) and white blood cells or bacteria (signs of possible infection). A CT scan with and without IV contrast (“CT urogram”) is performed for most patients to look in detail at the kidneys and ureters. In certain cases, a MRI of the abdomen and pelvis or a renal ultrasound is ordered as alternative to a CT scan.
A cystoscopy is used to look at the bladder in detail. If an abnormal area or growth is seen, a biopsy can be performed in which a small instrument is placed through the cystoscope to remove a piece of tissue for diagnosis. At the time of cystoscopy, the urologist may take a urine cytology or bladder washing.
Follow-up for a patient with hematuria will depend on the specific findings in the initial examination. Some patients need intervention and others simply require periodic retesting with repeat urinalysis and other tests.