Blood in Urine (Haematuria) Diagnosis and Treatment

What causes haematuria?

The causes of haematuria, whether gross or microscopic, are alike and can arise from any part of the urinary tract. Blood may begin from the ureters(the tubes connecting the kidneys to the bladder), kidneys, urethra, or bladder. Any sign of blood in the urine warrants medical investigation, even if it resolves without treatment.

Common causes include:

• Medications: Drugs like clopidogrel, aspirin, or warfarin, which affect blood clotting, can cause blood in the urine.
• Bladder or kidney stones: This can irritate or abrade your urinary tract, resulting in blood in the urine.
• Trauma: Injuries to the urinary tract or prostate may lead to haematuria.
• Cancer: Tumours anywhere in the urinary system may cause blood in the urine.
• Blood disorders: Clotting abnormalities may result in haematuria.
• Kidney diseases: Conditions affecting the kidneys can also cause bleeding.
• Infection: Urinary tract infections (UTIs), stemming from either the bladder or kidneys, are frequent causes of microscopic haematuria. Urine is naturally sterile and should not contain bacteria.

Diagnostic tests for haematuria

The diagnostic process for haematuria involves conducting a physical exam, taking a detailed medical history, and analysing the urine. A urine sample will be evaluated with a microscope, chemical test strips, and a culture to discover any bacterial infection.

Symptoms such as fever, chills, frequent or urgent urination, or pain during urination may imply an infection. Pain in the abdomen or flank, mainly if radiating to the groin, may indicate kidney or ureteral stone. Any recent trauma or medications should be discussed, as these could also contribute to the condition.

The physical examination may reveal specific causes. For instance, if you have a bruise in the back or abdominal area, it could suggest trauma. In men, a digital examination of the rectum may help identify conditions such as prostatitis, benign prostatic hyperplasia (BPH), or prostate cancer.

Other diagnostic tests include:

• Urinalysis and urine culture: To check for white blood cells, proteins, glucose, or kidney-related abnormalities.
• IVP (Intravenous Pyelogram): An alternative image test in which dye is injected into the veins, and X-rays are taken to identify any abnormality.
• Blood tests: To assess kidney function and detect any clotting disorder.
• CT scan: A comprehensive imaging test of the urinary system. Patients are given oral and intravenous contrast agents before images are taken of the abdominal and pelvic region.
• Urine cytology: A sample of urine is examined under a microscope to identify any abnormal or cancerous cells.
• Cystoscopy: This procedure involves inserting a thin, flexible camera through the urethra into the bladder to discover lesions or sources of bleeding. It is quick and typically performed under local anaesthetics.

Treatment for Haematuria

The treatment approach depends on the underlying cause of haematuria. In many cases, no identifiable cause is found despite thorough investigations. If this occurs, ongoing monitoring through repeat urinalysis and kidney function tests is often recommended.

For those above fifty years, yearly PSA (prostate-specific antigen) tests are advised to screen for cancer of the prostate. In African-Caribbean men, prostate screening typically starts at forty-five years due to higher risk, and earlier screening may be needed for individuals with a family history of prostate cancer.

If a specific cause of haematuria is identified, treatment will target that condition. This might include procedures to remove stones, antibiotics for infections, or other specialist interventions. A urologist will guide further management and recommend appropriate treatment.

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