Hematuria is defined as blood in the urine that is either seen or unseen (microscopic). When it is detected microscopically, it may be defined as trace, small, moderate or large depending on the number of red blood cells that are seen under the microscope.

There are many causes of hematuria, such as:

• Urinary Tract Infections (UTI)
• Kidney Stones- Movement of a kidney stone can irritate the lining of the kidney, ureter, bladder or urethra and cause hematuria. During movement of the stone, there may be flank pain.
• Atrophic Vaginitis, which is seen in many women after menopause. Lack of local estrogen causes the vaginal/urethral tissues to be come dry and less flexible. Patients may complain of dyspareunia (pain with sexual intercourse). Lack of moisture causes the tissues to break easily, and bleeding can occur.
• Renal Diseases, which can also be termed glomerulonephritis and include a host of medical conditions that effect the filtering properties of the kidney, such that red blood cells escape into the urine. Many times these conditions require no treatment, but other times medication is needed. Nephrologists (kidney specialists) are generally involved in evaluating and treating patients with the above findings.
• Cancer that occurs in the kidney, ureter, bladder, prostate or urethra may cause hematuria either with or without pain.

Diagnosis
To determine the cause of hematuria, several tests are used:

• Urine Culture is generally done at the time of the urinalysis to determine if there is an infection.
• Urine Cytology is a urine test that looks at the shapes of the cells in the urine to determine if they are normal or abnormal, and is useful in detecting some cancers.
• Renal Ultrasound is a non-invasive test done by a radiologist to evaluate the kidneys. By using an ultrasound probe that is pressed along the flank/back over the kidney, images of the kidney are seen. This can detect hydronephrosis (swelling), kidney stones, scarring (due to prior infections), or masses.
• IVP (Intravenous Pyelogram) uses an iodine dye, given intravenously, in order to visualize the kidneys and ureters and determine their function. Patients that are allergic to iodine contrast or shellfish should alert their physician, as they may not be able to have this exam.
• CT (CAT Scan) can be done with or without contrast. It is much faster than the IVP but does hold the same restriction to iodine contrast/shellfish allergies if using contrast.
• Cystoscopy will evaluate the bladder walls for possible polyps, stones or chronic infection.

Treatment
Treatment will depend on the cause of the hematuria.

• UTI will require antibiotics.
• Kidney stones may require drug therapy, shock wave lithotripsy (used to break up the stone), or surgical removal.
• Atrophic vaginitis is often times helped with local estrogen cream.
• Renal disease is treated medically with close follow-up with a Nephrologist.
• Cancer is treated surgically, depending on the organ affected.

For a referral to a Beth Israel urologist in Manhattan or Brooklyn for hematuria treatment, call our Physician Referral Service at 1-877-484-3466.