Microsoft word - blood in the urine fact sheet may 2013.doc
Blood in the urine (also known as haematuria) means the abnormal presence of red blood cells in the urine. It can turn urine pink, red, brownish-red or tea-coloured, which can be seen by the naked eye (macroscopic). Sometimes, it may only be found through a urine dipstick test or under a microscope (microscopic). Even when your urine is bright red, it is very unusual for enough blood to be lost to cause a problem. Half a teaspoon of blood is enough to turn a litre of urine red. Some medication or food can also make urine a dark colour.
Blood in the urine can occur with symptoms such as pain in the kidney area and/or a burning feeling when urinating. Sometimes there are no other symptoms – this is known as ‘asymptomatic’. It is always wise to check with your doctor if changes in urine colour persist. If there is visible blood in the urine – even once – you should see your doctor without delay.
Blood in the urine can come from anywhere in the kidneys, bladder or urinary tract. If the blood is coming from inside the kidneys, it is usually called ’glomerular bleeding’ as it comes from the glomeruli. The glomeruli are the tiny sets of looping blood vessels inside the nephrons. Each kidney contains up to one million nephrons, the working units of the kidneys. The glomeruli filter your blood allowing extra fluid and waste to pass into the tubule and become urine. In a healthy nephron, this filter helps to keep blood cells and protein in the bloodstream. If it does not come from the glomeruli, it is called ‘non-glomerular bleeding’ e.g. from the urinary tract or bladder. If blood in the urine is present without any other sign of kidney involvement it is called ‘isolated microscopic haematuria’. Some causes of asymptomatic microscopic haematuria are included in this table:
Thin basement membrane disease Hereditary nephritis (Alport’s syndrome)
Bladder cancer Kidney cancer Prostate cancer Urinary tract cancer Benign bladder polyps/ tumours
Bladder, prostate, urethra Kidney tuberculosis
Medullary sponge kidney Polycystic kidney disease
Analgesic papillary necrosis (cell death)
Kidney infarction (loss of blood flow) Kidney trauma/injury
Short-term microscopic haematuria can be caused by exercise, sexual intercourse, and injury. In women, small amounts of blood can be found in urine during their menstrual period.
Blood in the urine is one of the most common abnormalities found during routine check-ups. Its cause should always be investigated, whether it is macroscopic or microscopic, as the seriousness of ongoing bleeding cannot be determined until tests are completed. However in most cases, blood in the urine does not mean a serious or life threatening disease. When it is confirmed that persistent microscopic haematuria is present, your doctor may ask for a detailed medical history particularly in relation to previous urine tests and risk factors for bladder, kidney and urinary tract cancer. The risk factors for cancer include over 50 years of age, being male, smoking, heavy analgesic use, past cyclophosphamide use (a drug used to treat cancers) and exposure to toxic dyes. A physical examination may also be carried out. Your doctor may order further tests to find where the blood is coming from and be a basis for diagnosis, such as:
• A blood pressure check • Blood tests • A urinalysis, which is an examination of a sample of urine • A urinary tract ultrasound
If a glomerular source of bleeding cannot be identified, further tests may be needed, such as:
• Spiral computed tomography (CT) which is a special type of x-ray • Urine cytology, which is a test to look for abnormal cells in your urine
You will be given special instructions regarding the collection of urine. This will include the type of container to use (you may be provided with a special container), the time of day to collect the sample (usually first urine of the morning), and what part of the urine stream to collect. For example:
• ‘Initial’ collection is at the beginning of the stream – Initial blood
in the urine usually indicates bleeding is from the urethra, which is the tube taking urine from the bladder.
• ‘Terminal’ collection is at the end of the stream – Terminal blood
in the urine usually means bleeding is from where the urethra meets the bladder, bladder neck or base of the bladder.
• ‘Total’ collection is the entire stream of urine – Total blood in the
urine usually means bleeding occurs from the bladder or higher in the urinary tract.
It is important that you follow the instructions carefully. Don’t hesitate to ask questions if you are unsure.
Some causes of blood in the urine do not need any treatment while other causes may be serious. If blood in the urine is linked to a serious health problem, any treatment will work better if it is detected and diagnosed as soon as possible.
The management of glomerular and non-glomerular haematuria is quite different. Treatment will depend on the cause of blood in the urine. Your doctor can often monitor and provide long-term care for the cause of blood in the urine. Test results help determine the most appropriate management options and whether a referral to a specialist is needed.
Kidney Health Australia has a range of associated fact sheets containing related information, including ‘Kidney Stones’, ‘Kidney Cancer’, ‘Albuminuria’, ‘Urinary Tract Infections’, ‘Nephritis’ and ‘Polycystic Kidney Disease’. For more information about Kidney or Urinary health, please contact our free call Kidney Health Information Service (KHIS) on 1800 454 363. Alternatively you may wish to email KHIS@kidney.org.au or visit our website www.kidney.org.au to access free health literature.
This is intended as a general introduction to this topic and is not meant to substitute for your doctor's or Health Professional's advice. All care is taken to ensure that the information is relevant to the reader and applicable to each state in Australia. It should be noted that Kidney Health Australia recognises that each person's experience is individual and that variations do occur in treatment and management due to personal circumstances, the health professional and the state one lives in. Should you require further information always consult your doctor or health professional.
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