What is Haematuria?
Haematuria is the passage of blood in the urine. It may be microscopic or macroscopic, intermittent or continuous.
The pattern of blood in the urine may be initial, terminal or frank/total.
Blood in urine is a serious symptom and must always be fully investigated especially to exclude cancer.
Certain drugs and food products may colour urine red resulting in false haematuria and these should be differentiated from true haematuria, which is detected by microscopic examination of the urine.
Examples of such substances are rifampicin and rhodamine B food colouring used in cakes, cookies and soft drinks.
Occasionally vaginal bleeding may be mistaken for haematuria.
Definitive treatment depends on the cause.
Causes of Haematuria
Glomerular
- Glomerulonephritis usually presents with dysmorphic red blood cells in the urine or red blood cellcasts with proteinuria
Non-Glomerular
- Urethra: Trauma, Infection
- Bladder: Infection, stone, bladder cancer, varices, BPH, prostate cancer drug reaction (cyclophosphamide) radiation cystititis, parasite infestation (S. haematobium)
- Ureter: Infection, stone, tumour
- Kidney: Infection (pyelonephritis), stone, anatomic anomalies (Polycystic Kidney Disease, A-V Fistula) renal vein or artery thrombosis,
- Neoplasms: Renal cell carcinoma (Wilms Tumour)
- Trauma
- Sickle cell disease
- Benign Prostatic Hyperplasia (BPH)
- Carcinoma of prostate, bladder and kidney
- Urinary tract infection
- Urinary calculi
- Medical causes e.g. sickle cell disease, acute glomerulonephritis and anticoagulant therapy
Symptoms of Haematuria
- Fever suggests infection e.g. pyelonephritis, cystitis and prostatitis
- Colicky flank pain suggests urinary stones
- Associated lower urinary tract symptoms suggest bladder or prostatic cause
- Blood in the urine (on initiation, mixed with the urine, or at the end of passing urine) Pain/discomfort on passing urine usually associated with infection, calculi or trauma
- Painless intermittent haematuria associated with cancers eg bladder and kidney cancers
- Lower Urinary Tract Symptoms (LUTS)
- Loin pain
Signs of Haematuria
- Pallor
- Abdominal masses e.g. kidney, bladder
- Low or suprapubic tenderness from urinary tract infection or calculus
Investigations
- Blood urea, electrolyte and creatinine
- FBC and sickling status (Hb electrophoresis if sickling test is positive)
- Urinalysis Urine culture and sensitivity
- Abdominal and pelvic ultrasound
Treatment for Haematuria
Treatment objectives
- To treat underlying cause
- To arrest bleeding
Non-pharmacological treatment
- High fluid intake is advised in order to prevent clot formation in the urinary bladder
- If patient presents with clot retention, then catheterise and refer
Pharmacological treatment
A. For Urinary Schistosomiasis
Evidence Rating: [A]
- Praziquantel, oral,
(See ‘Urinary Schistosomiasis‘ for dosage)
B. For Urinary Tract Infection
- Give appropriate antibiotics (See ‘Urinary Tract Infection’) for details.
Referral Criteria
Refer all other cases as well as those with persistent haematuria for appropriate investigations and treatment.