What is Hematuria?
Hematuria is a medical condition in which there are too many red blood cells in the urine. It is a very common problem. In healthy subjects, they should not have any red blood cells in their urine or at most only a very minute amount of red blood cells are present. If there are more red blood cells in the urine than usual (> 4 RBCs/HPF), medical advice should be sought for at once.

Does red-colored urine always mean hematuria?
There are many causes of red-colored urine. Not all red-colored urine is hematuria. Red-colored urine may be caused by drugs or some form of dyes. They are not real hematuria. Blood from menstruation, vagina, or from hemorrhoid may contaminate urine and cause blood in the urine. We have to be very careful in assessing the source of the red blood cells in the urine.

Must hematuria be bright red in color?
Hematuria need not be bright red. It is only when fresh blood is present in the urine, the urine is bright red. When blood has come into the urine for a while and the urine has stayed in the urinary bladder for a period of time before passing out, the urine may have changed to a deep brown or tea-like color. It is because the hemoglobin inside the red blood cells has decomposed and the color would have changed.

What are the different types of hematuria?
Hematuria can be divided into microscopic hematuria and gross hematuria. Microscopic hematuria means that the red blood cells can only be detected by microscopy. Under naked eyes, the urine would have no difference from usual urine sample. Gross hematuria means that the blood in the urine can be seen with naked eyes.
According to the time of appearance of hematuria in the urine stream, hematuria can also be divided into early or terminal hematuria. Early hematuria is usually caused by pathology in the urethra, like trauma to the urethra, penile cancer, prostatitis, etc. Terminal hematuria is usually caused by pathology in the urinary bladder and posterior urethra, like cystitis, urinary bladder cancer, bladder stone, etc. Whole stream hematuria is usually caused by blood from the pathology in the upper urinary tract, like pyelonephritis, kidney stones, ureteric stone, etc.

What are the causes of hematuria?
There are many different causes of hematuria. Different parts of the urinary tract may bleed and produce hematuria. The causes include:
Stones: kidney stone, ureteric stone, urinary bladder stone, etc
Infection: cystitis, pyelonephritis, urethritis, prostatitis
Glomerulonephritis: acute glomerulonephritis, chronic glomerulonephritis, hereditary nephritis, etc
Cancer: Renal cancer, urinary bladder cancer, prostate cancer, etc
Congenital: Medullary sponge kidney, Polycystic Kidney Disease, etc

What are the common signs and symptoms of hematuria?
Common signs and symptoms of hematuria include:
If patient has kidney stone or ureteric stone, he may have loin pain, dysuria (pain during urination), difficulty in passing urine, etc
If patient has cystitis or prostatitis, he may have frequency, urgency, dysuria, etc. If he has pyelonehritis, he may have fever, chills, loin pain at the same time
If patient suffers from chronic glomerulonephritis, he may have swelling, hypertension, etc.
If patient has systemic illness, like hemophilia, he may have other bleeding from other parts of his body

What are the tests that need to be done?
Tests may include:
Urine culture to find out whether there is infection or not.
Cystoscopy: a scope to directly visualize the urinary bladder and find out whether there is any stone or cancer
X ray: KUB, IVP (intravenous pyelogram)
Others: Ultrasound, Radioisotope scan, CT scan, etc

What are the treatments?
As there are many different causes of hematuria, the treatment should be directed to the underlying cause. Different patient may have different treatment method and protocol. Patient should seek proper medical advice.

How to prevent hematuria?
The best way to prevent hematuria and also kidney problem is to have regular and balanced diet. Never eat something too salty or too greasy. Eat less meat. Eat more vegetables. More exercise.

Dr. Vincent Tam, Nephrologist
CT/No31 Jan,2003