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Trace intact blood urine: Urine Test Definition, Disease Detection, and Results

Blood in Urine (Hematuria) Causes, Treatments, and Symptoms

Having blood in your urine (pee) can be a sign that something is wrong with your kidneys or another part of your urinary tract. The medical name for blood in your urine is hematuria. There are two types of hematuria:

  • If you can see the blood in your urine, it is called gross hematuria.
  • If you cannot see the blood in your urine without looking at it under a microscope, it is called microscopic hematuria.

Anyone can have hematuria, but you might be more likely to have it if you:

  • Have a family history of kidney disease
  • Have an enlarged prostate (in men)
  • Have a history of getting kidney stones
  • Are taking certain medicines, such as pain relievers, blood thinners and antibiotics
  • Participate in strenuous (difficult) exercise
  • Have or recently had an infection

What are the causes of blood in urine?

There are many reasons that you might have blood in your urine. Having blood in your urine does not necessarily mean you have kidney disease. Some common causes are:

  • Menstruation
  • Strenuous (difficult) exercise
  • Sexual activity
  • Having a virus
  • Injury
  • Having an infection, such as a urinary tract infection (UTI)

Other more serious problems can also cause you to have blood in your urine. Some of these problems include:

  • Kidney or bladder cancer
  • Irritation or swelling in your kidneys, prostate (in men) or another part of your urinary tract
  • Polycystic kidney disease
  • Blood clots or diseases that cause problems with blood clotting
  • Sickle cell disease

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What are the symptoms of blood in urine?

You may not notice any symptoms if you have microscopic hematuria. If you have gross hematuria, you may notice that your urine is pink, red or brown. This happens because the blood in your urine makes it a different color. If you have gross hematuria, you may also get blood clots in your urine, which can be painful.

If you notice that your urine is a different color than normal or if you are having pain when you urinate, tell your health care provider. He or she can do some tests to figure out why you have blood in your urine or what is causing the pain and what treatment would be best for you.

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What is the treatment for blood in the urine?

The treatment for having blood in your urine depends on what is causing the problem. For example, if you have blood in your urine because of an infection, your doctor might tell you to take an antibiotic medicine. If you have blood in your urine for another reason, you might need a different kind of treatment.

To find out why you have blood in your urine, your doctor might ask you for a urine sample. The urine sample can be used to test for signs of an infection, kidney disease or other problems. Your doctor will use the results of the urine test to decide if you need more tests or if you can start a treatment.

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Blood in Urine (Hematuria) | Lab Tests Online

Sources Used in Current Review

(Updated July 2016). National Institute of Diabetes and Digestive and Kidney Diseases. Hematuria: Blood in the Urine. Available online at http://kidney.niddk.nih.gov/kudiseases/pubs/hematuria. Accessed on September 9, 2018.

Sobol, J. (Updated August 26, 2017). MedlinePlus Medical Encyclopedia. Urine – bloody. Available online at https://medlineplus.gov/ency/article/003138.htm. Accessed on September 9, 2018.

Shah, A.P. (Updated March 2017). Merck Manual for Healthcare Professionals. Isolated Hematuria. Available online at https://www.merckmanuals.com/professional/genitourinary-disorders/symptoms-of-genitourinary-disorders/isolated-hematuria. Accessed April 2014.

Davis, R., et al. (2012, validity confirmed 2016). American Urological Association. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults. Available online at https://www.auanet.org/guidelines/asymptomatic-microhematuria-(2012-reviewed-for-currency-2016). Accessed on September

Sources Used in Previous Reviews

(Updated 2012 April 16). Hematuria: Blood in the Urine. National Kidney and Urologic Diseases Information Clearinghouse [On-line information]. Available online at http://kidney.niddk.nih.gov/kudiseases/pubs/hematuria/. Accessed April 2014.

Dugdale, D. (Updated 2011 September 16). Urine – bloody. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003138.htm. Accessed April 2014.

Shah, A. (Revised 2013 July). Isolated Hematuria. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed April 2014.

Gulati, S. and Pena, D. (Updated 2013 March 25). Hematuria. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/981898-overview. Accessed April 2014.

Vivante, A. et. al. (© 2013). Hematuria and Risk for End-stage Kidney Disease. Medscape Multispecialty from Curr Opin Nephrol Hypertens. 2013;22(3):325-330. [On-line information]. Available online at http://www.medscape.com/viewarticle/803019. Accessed April 2014.

Basler, J. and Stanley, D. (Updated 2012 February 10). Hemorrhagic Cystitis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2056130-overview. Accessed April 2014.

Fatica, R. and Fowler, A. (Updated 2009 January 1). Hematuria. Cleveland Clinic [On-line information]. Available online at http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/evaluation-of-hematuria/. Accessed April 2014.

(Updated 2014 April 2). Glomerular Diseases. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) [On-line information]. Available online at http://kidney.niddk.nih.gov/kudiseases/pubs/glomerular/. Accessed April 2014.

(Reviewed 2011 January). Blood in the Urine (Hematuria). Urology Care Foundation [On-line information]. Available online at http://www.urologyhealth.org/urology/index.cfm?article=113&display=2. Accessed April 2014.

(Modified 2013 September 30). Bladder and Other Urothelial Cancers Screening (PDQ®). National Cancer Institute [On-line information]. Available online at http://www.cancer.gov/cancertopics/pdq/screening/bladder/patient/. Accessed April 2014.

Dugdale, D. (Updated 2013 August 18). RBC urine test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003582.htm. Accessed April 2014.

Mayo Clinic Staff (2011 September 1). Blood in urine (hematuria). Mayo Clinic [On-line information]. Available online at http://www. mayoclinic.org/diseases-conditions/blood-in-urine/basics/definition/CON-20032338?p=1. Accessed April 2014.

Silberberg, C. (Updated 2013 September 8). Alport syndrome. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000504.htm. Accessed April 2014.

Editorial Staff (Updated 2014 March). Microscopic Hematuria. Familydoctor.org [On-line information]. Available online at http://familydoctor.org/familydoctor/en/diseases-conditions/microscopic-hematuria.html. Accessed April 2014.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby’s Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 1000-1014.

RedUrine.com. Myoglobin. Available online at http://www.redurine.com/vitamins_and_nutrients/myoglobin.html. Accessed July 2014.

Hematuria in Adults | National Kidney Foundation

What is hematuria?

Hematuria means that red blood cells are in the urine. Urine does not normally contain red blood cells. The filters in the kidney prevent blood from entering the urine.  When you have hematuria, the filters in the kidneys or other parts of the urinary tract (the kidneys, ureter, and bladder that work together to remove wastes) allow blood to leak into the urine. There are two types of hematuria; microscopic or gross hematuria. Microscopic hematuria means that the blood can only be seen with a microscope. Gross hematuria means the urine appears red or the color of tea or cola to the naked eye.

What causes hematuria?

Hematuria is common and can have many different causes.

These causes include:

  • Inflammation of the kidney, urethra, bladder, or prostate (in men)
  • Abnormal structures in the urinary tract
  • Inherited diseases, like polycystic kidney disease , sickle cell disease, or hemophilia
  • Mineral imbalances in the urine
  • Glomerulonephritis
  • In some cases, no cause of hematuria may be found (idiopathic hematuria)

Structural Causes of Hematuria
Kidneys that contain cysts (fluid-filled sacs) or are blocked may lead to any type of hematuria. An ultrasound of the kidney can determine if an abnormal structure is causing blood in the urine.

Inherited Causes of Hematuria
Several different diseases that run in families can cause hematuria. These include Polycystic Kidney Disease, Alport Syndrome, inherited nephritis, certain types of hemophilia and, Sickle Cell disease in the African-American population.

Mineral Imbalances in the Urine
High levels of calcium in the urine can cause hematuria. The hematuria may be painless or cause pain in the area of the kidney and/or a burning feeling during urination. Those with high levels of calcium in the urine are more likely to have a family member with a history of kidney stones. Individuals that have this condition have a higher risk for having a kidney stone, but less than 10-15 percent develops a stone. Most adults with microscopic hematuria do not need treatment unless they have a kidney stone

Glomerulonephritis
Glomerulonephritis is a common cause of blood in the urine. There are many types of glomerulonephritis. Some of these are mild and resolve on their own while others are more serious and need medication. Blood tests can identify some kinds of glomerulonephritis.  In some cases, a kidney biopsy may be needed to find the exact form of the disease

Idiopathic hematuria
“Idiopathic” means that no specific cause can be found for blood in the urine. Idiopathic hematuria can run in families, and is called familial idiopathic hematuria. When there is not a family history of kidney failure and other medical tests are negative; usually, no treatment is needed.

What are the tests for hematuria?

Adults who have microscopic hematuria with normal blood pressure and kidney function should have their urine checked over several months. If blood in the urine continues:

  • A kidney ultrasound may be performed.
  • Urine should be checked for protein and may be checked for calcium and creatinine (a waste product found in your urine).
  • Blood test to determine kidney function and other tests may be performed.
  • If all tests are negative, and blood remains in the urine, yearly checkups should be done.

Adults who have microscopic hematuria with high blood pressure, abnormal blood tests, a family history of kidney disease or high levels of protein in the urine may need to have a kidney biopsy.

How is hematuria treated?

If your hematuria is caused by an infection, like a urinary tract infection (UTI), hematuria is treated with antibiotics. Your healthcare provider will test your urine after treating you with antibiotics to make sure that your infection has cleared. The goal of your healthcare provider is to find the cause of blood in your urine.  If no serious condition is causing hematuria, no treatment is needed.

Also in the A to Z Guide

Understanding your Lab Values

Urinalysis: What You Need to Know

What it means, ranges, and test results

Red blood cells (RBC) can be present in urine even when they are not visible to a person. The medical term for RBC in the urine is hematuria.

There are two types of hematuria. One is called “gross hematuria,” which occurs when a person can see the blood in their urine. The other type is “microscopic hematuria,” wherein a person cannot see the blood in their urine, despite the fact that RBC are present.

However, RBC in the urine is usually a symptom of an underlying health condition. A doctor will typically test for RBC content during a urine test. They will then use the results to help determine what the next course of action should be.

Keep reading for more information on what RBC in the urine might mean, normal and abnormal ranges, and typical test results.

There are several potential causes of RBC in the urine, including:

  • urinary tract infections (UTIs)
  • kidney or bladder infections
  • kidney stones
  • vigorous exercise, which requires the body to send lots of blood to the muscles
  • rhabdomyolysis, wherein severely damaged muscles cause substances from within the muscles to leak into the blood
  • sexual intercourse that causes irritated tissue

Also, some medications can cause RBC in the urine. Some potential medications that may lead to RBC in the urine include:

There are also some chronic conditions that can lead to RBC in the urine. These include:

  • sickle cell disease
  • hemophilia, which makes blood clotting harder for some people’s bodies
  • polycystic kidney disease, which occurs when cysts form on the kidneys
  • bladder or kidney cancer
  • enlarged prostate

In some cases, a person may not experience any additional symptoms of RBC in the urine. However, some conditions in the list above can also cause pain, swelling, or a fever.

Other symptoms a person might notice if they have a condition causing RBC in the urine include:

  • urine that looks pink, red, or the color of tea
  • a frequent need to urinate
  • pain or difficulty urinating
  • pain in the stomach or back
  • swollen feet, legs, or ankles

If a person notices blood in their urine, they should talk to their doctor as soon as possible.

In most cases, a doctor will discover RBC in the urine during a urinalysis. A urinalysis checks for several key health indicators following the delivery of a urine sample.

The ideal sample uses the “clean catch” method. The clean catch method involves starting the flow of urine and placing the collection cup into the flow midstream. This helps remove any potential contamination from bacteria or other substances that may be near the genitals.

Learn more about urinalysis here.

In some cases, a doctor can use a simple dipstick to test the urine for blood. A dipstick is a piece of paper with chemicals on it. These chemicals react with different substances that may be present in the urine. In the case of looking for RBC, a dipstick will turn a different color if RBC is present.

After this, the doctor will send the sample to a laboratory for further testing. The laboratory staff can provide more information about the amount of RBC, as well as any other substances that could indicate an underlying condition, in the urine.

A very small amount of RBC may be present in a normal urine sample. In fact, according to the Icahn School of Medicine at Mount Sinai in New York, the normal range for RBC in the urine is up to four RBC per high power field.

However, different laboratories may have different ranges for a “normal” result. For this reason, a person may wish to talk to their doctor about what their test results mean.

An abnormal range can indicate any one of a number of potential issues. Some of the possible conditions include:

  • kidney or other urinary tract problems, such as an infection, a tumor, or stones
  • problems with the prostate
  • bladder or kidney cancer

If a test reveals that a person has RBC in their urine, a doctor will likely run additional tests. For example, they might want to carry out:

  • blood tests
  • CT or MRI scans, to examine the kidneys and urinary tract
  • a biopsy of the kidneys
  • cystoscopy, wherein they will use a thin, flexible tool to examine the urinary tract

A doctor will also ask about any other symptoms a person is experiencing that may indicate an underlying health condition. A person should discuss their concerns with their doctor before providing a urine sample.

It is also important to note that sometimes, a test may generate a false reading. This can occur if a person takes the test while menstruating, for example. In this case, blood can get into the urine sample and cause a false reading.

Pregnant women should not see blood in their urine. If they do, they should let their healthcare team know right away. If they provide a urine sample with blood in it, a doctor will try to diagnose and treat any underlying conditions.

Since UTIs are common during pregnancy, the most likely cause of blood in the urine is a UTI.

However, a doctor may run tests and ask questions to rule out other potential issues.

RBC in the urine can indicate that there is a problem with the urinary tract. If a person discovers blood in their urine, they should contact their healthcare provider.

If a test confirms the presence of RBC in the urine, a doctor will likely want to run further tests to figure out what is causing it. Often, the cause is treatable.

Microscopic Hematuria – familydoctor.org

Your doctor will usually start by asking you for a urine sample. He or she will test your urine (urinalysis) for the presence of red blood cells. Your doctor will also check for other things that might explain what’s wrong. For example, white blood cells in your urine usually means you have an infection. If you do have blood in your urine, your doctor will ask you some questions to find out what caused it.

If the cause isn’t clear, you may need more tests. These may include:

  • A blood test.
  • An ultrasound.
  • A computed tomography (CT) scan.
  • A magnetic resonance imaging (MRI) test.
  • An How do I give a urine sample?

    A nurse will give you an antiseptic wipe to clean yourself and a sterile urine collection cup. In the bathroom, wash your hands with soap and warm water first.

    • For women: Use the antiseptic wipe to clean your vagina. Do this by wiping yourself from front to back 3 times before you urinate. Fold the wipe each time you use it, so that you are wiping with a clean part each time.
    • For men: Use the antiseptic wipe to clean the head of your penis. If you’re not circumcised, pull the foreskin back behind the head of the penis before you use the wipe. Move the wipe around the head of your penis before you urinate.
    • Start urinating in the toilet. About halfway through the urination, start catching the urine in the cup.
    • Wash your hands with soap and warm water.
    • Give the sample to the nurse. Someone will look at your urine under a microscope to see if it has blood in it.

    Urine Dipstick Analysis; Performing Urine Dipstick Analysis

    Instructions

    • All samples should be midstream and collected in a clean sterile container.
    • Suprapubic aspiration or fresh catheter samples are ideal, but not always practical.
    • The gold standard method of testing is to remove a small volume of urine from the sterile container with a fresh sterile syringe, and then apply the removed urine to the dipstick. In this way, the remainder of the collected sample contents remains untouched by a potentially unsterile dipstick and so can be sent for laboratory analysis if required.
    • Hold the dipstick horizontally before reading.

    Available tests

    These include:

    • Multistix®: suitable for screening for glycosuria only.
    • Micral-Test II® or Microalbustix®: detect microalbuminuria.
    • Multiple combination strips – five tests on each strip: detects blood, ketones, glucose, pH and protein.
    • Multiple combination strips – seven tests on each strip: tests for blood, ketones, glucose, pH, bilirubin, urobilinogen and protein.

    Costs vary depending on how many substances can be detected and the supplier.

    Physical examination

    Colour

    The colour of the urine can vary greatly. Normal urine varies from colourless to dark yellow. Various factors can affect urine colour.

    Common Causes of Urine Discolouration
    Colour Pathological causes Food and drug causes
    Brown Bile pigments, myoglobin Levodopa, metronidazole, nitrofurantoin, some antimalarial agents, fava beans
    Brownish-black Bile pigments, melanin, methaemoglobin Cascara, levodopa, methyldopa, senna
    Green or blue Pseudomonal urinary tract infection (UTI), biliverdin Amitriptyline, indigo carmine, IV cimetidine, IV promethazine, methylthioninium chloride, triamterene
    Orange Bile pigments Phenothiazines, phenazopyridine, rifampicin, hydroxocobalamin
    Red Haematuria, haemoglobinuria, myoglobinuria, porphyria Beetroot, blackberries, rhubarb, phenolphthalein, rifampicin
    Yellow Concentrated urine (orange to gold in dehydration) Carrots, cascara

    Turbidity

    Cloudy urine may be due to:

    • Contamination with vaginal mucus or epithelial cells.
    • Excess phosphate crystals precipitating in alkaline urine (no clinical significance).
    • Pyuria secondary to infection.
    • Chyluria (presence of chyle/lymph in the urine – usually secondary to filariasis).
    • Hyperuricosuria secondary to a diet high in purine-rich foods.
    • Lipiduria.
    • Hyperoxaluria.

    One study has recently shown that Gram-negative organisms can be accurately identified directly from an inoculum prepared from centrifuged turbid urine specimens[1]. This method permits the reporting of the complete results on urine specimens as early as eight hours after their arrival in the laboratory. The most important benefit is the faster pathogen identification and susceptibility data, which allow earlier selective antimicrobial therapy.

    Odour

    The normal odour is described as urinoid. In concentrated specimens this can be strong but does not imply infection, which has a more pungent smell. Alkaline fermentation causes an ammoniacal smell, and patients with diabetic ketoacidosis produce a urine that may have a sweet or fruity odour.

    Other causes of abnormal odours are cystine decomposition (a sulphuric smell), gastrointestinal-bladder fistulae (a faecal smell), medications (eg, vitamin B6), and diet (eg, asparagus[2]).

    Specific gravity

    • Specific gravity (SG) <1.008 is dilute and >1.020 is concentrated.
    • Increased SG is seen in conditions causing dehydration, glycosuria, renal artery stenosis, heart failure (secondary to decreased blood flow to the kidneys), inappropriate antidiuretic hormone secretion and proteinuria.
    • Some dipsticks give falsely high readings in the presence of dextran solutions and IV radiopaque dyes, but this varies, so check the manufacturer’s leaflet.
    • Urine SG may have low specificity in many in some situations[3].
    • Decreased SG is seen in excessive fluid intake, renal failure, pyelonephritis, and central and nephrogenic diabetes insipidus .
    • False low readings are associated with alkaline urine (eg, a high-citrate diet).

    pH

    • The range is 4.5 to 8, but urine is commonly acidic (ie 5.5-6.5) due to metabolic activity.
    • Acidic urine (low pH) may be caused by diet (eg, acidic fruits such as cranberries) and uric acid calculi. Spot urine pH by dipstick is not an accurate method for evaluation of the patients with urolithiasis. Patients with alkaline urine are more prone to error with reliance on spot pH[4].
    • Urine pH generally reflects the blood pH but in renal tubular acidosis (RTA) this is not always the case. If the blood is more acidic than it should be and the urine less acidic than it should be then the possibility of RTA should be considered:
      • In type 1 RTA (distal) the urine and the blood are both acidic.
      • In type 2 (proximal) the urine is initially alkaline but becomes more acidic as the disease progresses.
    • Alkaline urine (high pH) is also seen with infection with urease-splitting organisms, and may be associated with the formation of stag-horn calculi.

    Haematuria

    See also the separate Haematuria article.

    • A positive test indicates either haematuria, haemoglobinuria or myoglobinuria.
    • Dipstick tests for the presence of haemoglobin with the degree of colour change directly related to amount present.
    • Free haemoglobin or myoglobin causes field change, whereas intact red blood cells (RBCs) are broken down on contact with the reagent pad and release local haemoglobin, producing a dot. These coalesce when >250 RBCs/ml.
    • False positive readings are most often due to contamination with menstrual blood; they are also seen with dehydration which concentrates the number of RBCs produced, and exercise.
    • False negative readings: captopril, vitamin C, proteinuria, elevated SG, pH less than 5.1 and bacteriuria.
    • Dipstick testing for haematuria is the best screening tool[5].
    • Prognostic significance of a positive test is very controversial – rates ranging from 0.5-6% of patients with a positive test have been found to have underlying significant pathology.

    Proteinuria

    See also the separate Proteinuria article.

    • Healthy adults normally excrete 80-150 mg protein in urine daily. Normal urinary proteins include serum globulins, albumin, and proteins secreted by the nephron.
    • Proteinuria is defined as albumin:creatinine ratio >30 mg/mmol or albumin concentration >200 mg/L. Clinical proteinuria is indicated at greater than 0.5 g of protein per day (greater or equal to 250 mg/L on a test strip). The dipstick test is a widely used screening tool for albuminuria, as a marker for chronic kidney disease, but the albumin:creatinine ratio (ACR) has advantages over the test in sensitivity and quantification of levels[6].
    • Detectible proteinuria may be the first sign of renovascular, glomerular or tubulo-interstitial renal disease. Alternatively, it may be caused by overflow of abnormal proteins in diseases such as multiple myeloma.
    • Most dipstick tests will pick up albumin but may not detect low concentrations of Bence Jones’ protein or gamma-globulins. Bence Jones’ protein can be detected by a specific antibody test on a midstream sample, whilst urine gamma-globulins can be detected by urine electrophoresis.
    • False negatives: alkaline or dilute urine or when primary protein is not albumin[7]. A more accurate method is to precipitate urinary proteins with 3% sulfosalicylic acid (detects at 2.5 mg/L and detects other proteins). If urine is negative on dipstick but strongly positive with sulfosalicylic acid, suspect multiple myeloma.
    • Persistent significant proteinuria detected by dipstick requires further assessment with 24-hour urinary protein excretion, urinary protein:creatinine ratio, microscopic examination of the urinary sediment, urinary protein electrophoresis, and assessment of renal function.
    • Microalbuminuria can be detected with Micral-Test II® or Microbumintest® but this should be followed by confirmation in the laboratory, since false positive results are common.

    Glucose

    See also the separate Glycosuria article.

    • Nearly all glucose filtered by the glomeruli is reabsorbed in the proximal tubules and only undetectable amounts appear in urine in healthy patients. Above the renal threshold (10 mmol/L) glucose will appear in urine. The test relies upon reaction of glucose with glucose oxidase on dipstick to form hydrogen peroxide which causes colour change. This is specific to glucose and no other sugar.
    • Useful screen for diabetes mellitus.
    • False positive results: seen when high levels of ketones are present. Also seen in patients taking levodopa.
    • False negatives: seen where SG is elevated, in uricosuria and in patients taking ascorbic acid.

    Ketones

    See also the separate Urinary Ketones article.

    • Ketones are not normally found in urine.
    • Dipstick tests for the presence of acetoacetic acid at 5-10 mg/dL but not acetone or beta-hydroxybutyric acid. The urine ketone level has been found to be negative in more than half of the patients whose capillary blood ketone level was positive which has implications for the management of diabetic ketoacidosis[8].
    • A positive test is associated with uncontrolled diabetes, pregnancy without diabetes, carbohydrate-free diets and starvation.
    • False trace results may be seen in highly pigmented urine and in patients taking levodopa.
    • Delay in testing a sample may result in a false negative result.

    Bilirubin and urobilinogen

    See also the separate Bilirubinuria article.

    • Unconjugated bilirubin is water-insoluble and not normally present in the urine.
    • Conjugated bilirubin only appears in urine in the presence of liver disease or obstruction of the bile ducts.
    • A small amount of urobilinogen is normally found in urine, but significant amounts suggest that further assessment for haemolytic and hepatocellular disease is indicated.
    • Urobilinogen levels can be increased in conditions associated with elevated nitrite levels (eg, UTIs).

    Leukocyte esterase and nitrite test

    Nitrites

    • This test relies on the breakdown of urinary nitrates to nitrites, which are not found in normal urine.
    • Many Gram-negative and some Gram-positive bacteria are capable of producing this reaction and a positive test suggests their presence in significant numbers (ie more than 10,000 per ml). A negative result does not rule out a UTI.
    • The reagent is highly sensitive to air exposure, which may cause a false positive response.
    • False negative results may be seen where:
      • Bladder incubation time is shortened (less than four hours).
      • There is absence of dietary nitrate.
      • There is presence of nitrate reductase-negative organisms (eg, some mycobacteria strains).
      • Urine SG is elevated.
      • The pH is less than 6.0.
      • There is presence of urobilinogen and urinary vitamin C.

    Leukocyte esterase

    • This relies on the reaction of leukocyte esterase produced by neutrophils and a positive result suggests pyuria associated with UTI.
    • Isolated trace results may be of questionable significance, but repeated ones should not be ignored.
    • False positive results may be caused by contamination with vaginal discharge.
    • Elevated urine glucose or oxalic acid concentrations may reduce sensitivity, and this may also be seen in patients taking tetracycline or cefalexin.

    Efficacy

    A negative urine culture can be predicted by negative dipstick test results. Therefore dipstick testing may be a reliable predictor of negative urine culture[9]. In this study the percentage of positive cultures was 17.5%. Nitrite had 28% sensitivity and 99% specificity, with positive and negative predictive values of 89% and 87%, respectively. Leukocyte esterase had 79% sensitivity and 84% specificity, with positive and negative predictive values of 51% and 95%, respectively. The combination of positive nitrite or positive leukocyte esterase tests had 85% sensitivity and 84% specificity, with positive and negative predictive values of 53% and 96%, respectively.

    Understanding Urinalysis in Dogs | Morris Animal Foundation

    September 19, 2016 – In previous newsletters, we discussed the interpretation of complete blood counts and blood chemistry. The final component of routine clinical pathology is urinalysis. Kidneys can be thought of as factories responsible for: a) removing waste products and drugs from the body; b) balancing body fluids; and c) performing other essential metabolic functions. Where do the products from all this hard work go? The urine, of course! For this reason, examination of urine samples gives us essential information about the work kidneys are doing and how well they are doing it.

    Urinalysis is the physical, chemical and microscopic evaluation of urine. Let’s explore routinely performed tests and what their results mean.

    Color: Normal urine is transparent, and yellow or amber on visual inspection. Abnormal urine color may be caused by presence of pigments or blood, but it does not provide specific information about abnormalities by itself.

    Clarity: Urine is normally clear. When pigment, infection, crystals, or fat are present, urine can become cloudy.

    Specific Gravity: This test is a measure of urine concentration. Elevated urine specific gravity indicates dehydration, and that the kidneys are reabsorbing as much fluid as possible. Low specific gravity indicates the urine is diluted. Normally, this means the kidneys are excreting extra water due to, for instance, excessive water intake or administration of intravenous fluids. However, dilute urine in a clinically dehydrated animal is abnormal and could be caused by disease states such as kidney failure, hypoadrenocorticism (Addison’s disease), hyperadrenocorticism (Cushing’s disease), high blood calcium, or diabetes mellitus.

    Urine pH: Urine normally is acidic in dogs but varies depending on diet, medication administration, and/or presence of disease. For example, some bacterial urinary tract infections can result in alkaline urine. Urine pH affects the formation of crystals and stones in the bladder and kidneys. Some types of kidney or bladder stones can be treated or prevented by feeding diets that manage urinary pH.

    Protein: As a general rule, normal urine should not contain protein. Protein in urine (proteinuria) is a result of numerous causes including strenuous exercise, kidney disease, and infection. Because so many different conditions cause proteinuria, the condition must be interpreted in light of many other factors. For example, a trace amount of protein in concentrated urine is less significant than a trace amount of protein in dilute urine. If proteinuria is present without an obvious explanation (e.g., dehydration or evidence of infection), its significance can be verified by measuring the urine protein concentration in the context of kidney function, indicated by the urine creatinine concentration. This test is called a urinary protein creatinine (UPC) ratio and is not part of a routine urinalysis.

    Glucose: Normally, glucose should not be present in urine. By far, the most common reason for glucosuria is diabetes mellitus. Less common causes of glucosuria include serum glucose overload, such as from intravenous administration, or damage to the kidney tubules resulting in excretion of glucose into the urine.

    Ketones: Normally there should not be ketones in the urine, as ketones are abnormal compounds produced when the body burns fat instead of carbohydrate. The presence of urinary ketones usually is associated with diabetes mellitus, but can sometimes be seen with consumption of a low-carbohydrate diet, prolonged fasting or starvation.

    Bilirubin/Urobilinogen: Bilirubin is a byproduct of red blood cell breakdown and is excreted by the liver. In dogs with concentrated urine, a small amount of urinary bilirubin can be normal, especially in male dogs. However, high urinary bilirubin often is associated with liver disease or diseases causing accelerated breakdown of red blood cells. A small amount of urinary urobilinogen also is normal, however the test is not specific enough to be clinically useful.

    Occult Blood: A positive result on this test for blood in the urine can be due to hemorrhage, accelerated breakdown of red blood cells, or the presence of a byproduct of severe muscle breakdown called myoglobin. Discolored urine may yield false-positive results. A positive result should be followed with microscopic examination of urine sediment for red blood cells.
    The next series of tests are performed microscopically on urine that has been centrifuged to allow heavier particulates and cells to fall out (the sediment). The sediment is collected and examined microscopically.

    Red Blood Cells: Normal urine should contain very few red blood cells. Increased red blood cells in urine samples indicates bleeding somewhere in the urinary or genital tracts.

    White Blood Cells: Normal urine should contain very few white blood cells. Increased white blood cells (pyuria) can occur due to inflammation, infection, trauma, or cancer.

    Epithelial Cells: Transitional epithelial cells, shed into the urine from the bladder and proximal urethra, are sometimes seen in urine sediment. In a voided urine sample, squamous epithelial cells may be seen. However, cancerous transitional cells or other abnormal cells may be seen in an animal with certain types of bladder cancer.

    Casts: Casts are clumps of cells. A few casts found in urine are considered normal. However, presence of casts in high numbers indicates kidney damage, and may be one of the earliest laboratory abnormalities noted with toxic damage to renal epithelial cells.

    Infectious Organisms: The kidneys and bladder are sterile so the presence of bacteria in urine collected by cystocentesis usually indicates infection. Small numbers of bacteria from the skin of the genitalia may contaminate voided samples or samples collected by catheterization and do not indicate infection.

    Crystals: Many different types of crystals may be present in urine and the type of crystal formed depends on urine pH, urine temperature, and length of time between urine collection and examination. Crystals in urine are not necessarily pathologic, but some types of crystals may indicate illness or an inherited metabolic problem. Struvite crystals are commonly seen in dogs and are not generally a problem unless there is a concurrent bacterial urinary tract infection. Calcium oxalate crystals are less common in dogs and, if persistent, may indicate an increased risk of calcium oxalate bladder stone formation. Rarer crystal types include ammonium acid urate crystals, which suggest liver disease, and an unusual form of calcium oxalate crystals, seen in association with antifreeze toxicity.

    Lipids: Fat droplets commonly are present in urine from dogs and are not considered to be pathologic.

    Spermatozoa: Spermatozoa may be seen normally in urine collected from reproductively intact male dogs.

    Next time you are in the yard, with your collection tool of choice in hand to capture your dog’s urine, keep in mind all the valuable information the Golden Retriever Lifetime Study is gaining from your efforts.

    90,000 Blood in urine (hematuria) | Symptoms, complications, diagnosis and treatment

    Blood in urine can be a warning sign. Although the cause is harmless in many cases, blood in the urine (hematuria) can indicate a serious disorder. Treatment depends on the cause.

    Blood in urine can be referred to in two terms. If the blood is visible to the eye, that is, the urine has a pink or burgundy color, then this condition is called gross hematuria.If the urine has the usual color, but in the analysis of urine, an increased content of erythrocytes, that is, blood elements, is detected, then this condition is called microhematuria. This article will focus on the visible impurity of blood in the urine (gross hematuria).

    Certain medicines and foods, such as beets, rhubarb and certain types of berries, can cause redness in the urine. To determine exactly whether the cause of this discoloration of urine is an impurity of blood or not, it is necessary to pass a urine test.

    Symptoms

    Hematuria produces pink, red, or cola-colored urine due to the presence of red blood cells. The urine has a pink color, or a color of the color of “meat slops”. Blood clots in the form of black “worms”, “cakes”, and long threads can also be detected in the urine. At the same time, there may be pain when urinating, or pain in the lumbar region.

    When to see a doctor

    Make an appointment with your doctor anytime you notice blood in your urine.

    Certain medications such as laxatives and certain foods, including beets, rhubarb and berries, can cause the urine to turn red. Urine discoloration caused by drugs, food, or exercise can go away within a few days.

    Bloody urine looks different, but you cannot tell the difference. It is best to consult your doctor any time you see red colored urine.

    Causes of hematuria.

    • Urinary tract infections (most commonly acute cystitis) – This happens when bacteria enter your body through the urethra and multiply in your bladder. Symptoms may include persistent urge to urinate, pain and burning sensation when urinating, and extremely odorous urine.
    • Kidney infection (acute pyelonephritis) – This can happen when bacteria enter the kidneys from your bloodstream or pass from the ureters to the kidneys.Signs and symptoms are often similar to those of a bladder infection, although kidney infections are more likely to cause fever and side pain.
    • Stone of the bladder, kidney or ureter – Minerals in concentrated urine sometimes form crystals on the walls of the kidneys or bladder. Over time, crystals can become small, hard stones.
      Stones are generally painless, so you probably won’t know you have them unless they cause blockages or transfer.Then usually no symptoms occur – kidney stones, especially, can cause excruciating pain. Bladder or kidney stones can also cause severe or microscopic bleeding.
    • Enlarged prostate in older men The prostatic gland, which is located just below the bladder and surrounds the upper urethra, often enlarges as men approach middle age. It then compresses the urethra, partially blocking the flow of urine.Signs and symptoms of an enlarged prostate (benign prostatic hyperplasia) include difficulty urinating, an urgent or persistent need to urinate, and visible or microscopic blood in the urine. An infection of the prostate gland (prostatitis) can cause the same symptoms. …
    • Prostate infection (acute prostatitis) .
    • Kidney disease (glomerulonephritis) – Microscopic urinary bleeding is a common symptom of glomerulonephritis, an inflammation of the kidney’s filtration system.Glomerulonephritis can be part of a systemic disease such as diabetes, or it can occur on its own. Viral or streptococcal infections, blood vessel diseases (vasculitis), and immune problems such as IgA nephropathy that affect the small capillaries that filter blood in the kidneys (glomeruli) can cause glomerulonephritis.
    • In women, menstrual blood contamination of urine during menstruation.
    • Kidney injury – Impact or other injury to the kidney from an accident or physical contact may cause visible blood in the urine….
    • Bladder cancer (most often smokers suffer).
    • Cancer of the kidney, pelvis, ureter -Visible urinary bleeding may be a sign of kidney, bladder, or prostate cancer. Unfortunately, there may be no signs or symptoms in the early stages when these cancers are more treatable. …
    • Medication (eg nonsteroidal anti-inflammatory drugs to relieve joint pain) – the anti-cancer drug cyclophosphamide and penicillin can cause urination.Visible urinary blood sometimes occurs if you are taking an anticoagulant such as aspirin and thinner heparin and you also have a condition that causes your bladder to bleed ..
    • Intense physical activity – Rarely intense exercise can lead to gross hematuria, but the cause is unknown. It could be due to trauma to the bladder, dehydration, or the breakdown of red blood cells that occurs with prolonged aerobic exercise.

    When to see a doctor.

    An admixture of blood in the urine can be a symptom of a serious illness, therefore it is necessary to contact a urologist . The urologist will prescribe examinations to find a clarification of the diagnosis. First of all, it is necessary to exclude malignant lesions of the organs of the urinary system, which, although not often detected, can pose a serious threat to health

    Almost everyone, including children and adolescents, may have red blood cells in their urine.

    Factors that make this more likely include:

    • Age. Many men over 50 years of age experience occasional hematuria due to an enlarged prostate gland.
    • Recent infection. Inflammation of the kidneys after a viral or bacterial infection (post-infectious glomerulonephritis) is one of the leading causes of visible urinary blood in children.
    • Heredity. You may be more prone to urinating if you have a family history of kidney disease or kidney stones.Sickle cell anemia, a hereditary defect in hemoglobin in red blood cells, causes blood in the urine, both visible and microscopic hematuria. This can cause Alport’s syndrome, which affects the filter membranes in the glomeruli of the kidneys.
    • Certain medicines. Aspirin, nonsteroidal anti-inflammatory pain relievers, and antibiotics such as penicillin are known to increase the risk of urinary bleeding.
    • Physical activity. Long distance runners are especially prone to physiological bleeding caused by exercise. In fact, this condition is sometimes called runner’s hematuria. But anyone who works hard can have the symptoms described.

    Diagnostics

    Your urologist will determine the presence of risk factors for urinary tract cancer and possible other causes of blood in the urine. The most common risk factors for the development of cancer are smoking, previous radiation or chemotherapy, exposure to adverse industrial factors (dyes, solvents).Depending on the age, the presence of risk factors, symptoms, the urologist will assess the amount of the necessary examination.

    Survey

    The purpose of the survey is to find the source of blood impurities in the urine. For examination of the bladder, ultrasound and cystoscopy are usually performed. For examination of the upper urinary tract (kidneys and ureters), an ultrasound scan or computed tomography with the introduction of contrast (CT-urography) is necessary. Laboratory tests usually include urine culture to rule out infection, a creatinine blood test, and a CBC.

    Treatment

    Treatment depends on the cause of the hematuria. In the presence of cancer or stones, surgical treatment is necessary. In most other cases, medications can be dispensed with.

    In the urological department of VTSERM Nikiforov EMERCOM of Russia you can get the full range of necessary assistance

    The urological department is one of the first in the city in terms of the quality of medical care for patients with urological pathology, including those developed in emergency situations.Such high results were achieved thanks to the continuous improvement of the qualifications of the doctors of the department (6 people, most of whom have a scientific degree), including on the basis of clinics in the USA and Germany, a clear delineation of functions, as well as advanced equipment of the department, which allows performing operational and diagnostic manipulations of any category of complexity.

    You can get comprehensive advice on your problem from highly qualified doctors of the department.

    For more information, go to the branch page.

    Hematuria (blood in urine): causes and treatments

    There are many reasons for the appearance of blood in the urine. This condition, known as hematuria, can be a serious sign of a serious illness or a minor change in the body.

    What if you see blood in your urine?

    Hematuria is defined as the presence of red blood cells in the urine.It can be described as “macrohematuria”, when blood in the urine is visible with the naked eye, or “microhematuria”, in the case of determining red blood cells under a microscope in urinalysis. Hematuria can occur from any part of the urinary tract, including the kidneys, ureters, bladder, prostate, and urethra. In many patients, during the examination, serious causes leading to hematuria are not determined, however, it is necessary to know that hematuria can be a manifestation of both infection, urolithiasis, and benign and malignant tumors of the urinary tract.Smoking, radiation, abuse of certain drugs, severe pain syndrome, exposure to certain chemicals can all lead to hematuria.

    What are the common causes of hematuria?

    Blood in the urine is often not a sign of illness. Studies have shown that 9 to 18 percent of healthy people may have clinically insignificant microhematuria. However, hematuria is often a warning signal for immediate treatment. Below is a list of the most common causes of hematuria:

    • Bladder cancer.
    • Kidney cancer.
    • Prostate cancer.
    • Cancer of the ureter.
    • Cancer of the urethra.
    • Urolithiasis.
    • Urinary tract infection.
    • Pyelonephritis (kidney infection).
    • Kidney disease (hydronephrosis, polycystic, tuberculosis).
    • Benign prostatic hyperplasia.
    • Radiation or chemical cystitis.
    • Injury of the urinary system.
    • Prostatitis.
    • Severe physical overvoltage.

    How to detect hematuria?

    Visible hematuria often disturbs patients and forces them to seek medical attention.

    Microhematuria is determined by microscopy of urine sediment.

    What research is needed to make a diagnosis?

    A comprehensive assessment of the urinary tract should be performed in any patient with gross hematuria or severe hematuria.The first step is a thorough history taking and physical examination. Next, a laboratory analysis of urine and a study of urinary sediment under a microscope are carried out. The urine is tested for protein (a sign of kidney disease) and urinary tract infections. The number of red blood cells in the urine (erythrocyturia), the content of leukocytes in the urine (leukocyturia) are determined. A urine cytology test is needed to check for abnormal cells. Laboratory blood tests are performed to measure serum creatinine levels (as determined by renal function).

    Patients with significant urine protein or elevated creatinine levels should undergo additional testing to rule out kidney disease.

    A complete urological examination in patients with hematuria also includes an x-ray of the kidneys, ureters and bladder (an overview of the urinary system) to exclude masses and stones. Excretory urography is performed – a method for determining renal function, based on the introduction of X-ray contrast agents into the bloodstream, followed by radiography and determination of the excretion of dye by the kidneys.Many doctors may choose other imaging studies such as computed tomography (CT), multislice computed tomography (MSCT). These methods are preferred and more informative for assessing kidney health and are also the best methods for assessing urinary stones. Recently, many urologists have been using CT urography. This allows the urologist to view the kidneys and assess the condition of the ureters as a result of a single X-ray. In patients with elevated creatinine levels or allergies to X-ray contrast agents, magnetic resonance imaging (MRI) or retrograde pyelography is done to evaluate the upper urinary tract.During retrograde pyelography, the patient is taken to the operating room, an X-ray contrast agent is injected into the kidney through the ureteral catheter, followed by X-ray.

    Patients with hematuria undergo cystoscopy under local anesthesia using a rigid or, more often, flexible instrument – a cystoscope. After anesthesia through the urethra, a cystoscope is inserted into the bladder and the bladder and urethra are assessed for lesions.

    What to do if hematuria was or is, and the reasons were not found as a result of the examination?

    In at least 8-10 percent of cases, no cause for hematuria has been found.Some studies have shown an even higher percentage of patients without a cause. Unfortunately, we have to state that the same studies later showed that 3 percent of patients later were found to have malignant tumors of the urinary system.

    Thus, there is a risk of under-examination of the patient or inability to determine the initial stages of some formations. There are no recommendations for follow-up due diligence. Also, there is still no consensus among urologists on this topic.

    It is still recommended to consider repeating urine and cytology tests at 6, 12, 24 and 36 months. In the case of repeated gross hematuria, a positive result of a cytological study of urine or the appearance of irritating urinary symptoms, such as pain during urination or frequent urination, an immediate reassessment of the state of the urinary system is carried out with cystoscopy and repeated methods of radiation diagnostics. If none of these symptoms are present within three years, no further urologic evaluation is required.

    How to treat?

    Treatment is based on a physician’s assessment of the patient’s condition, symptoms and medical history, as well as the causes of hematuria!

    Blood in the Urine

    Blood in the urine (hematuria) can appear for a variety of reasons. If this happens after an injury (such as a car accident or fall), in most cases it is a sign of a bruised kidney or bladder. Common causes of blood in the urine include urinary tract infections, kidney stones, inflammation, tumors, and a variety of other kidney or bladder disorders.Blood may also appear in a urine sample during menstruation, although the blood does not come from the urinary tract.

    If only a small amount of blood is present, a urinalysis will show it is present, even though the color of the urine is yellow and not pink or red. This is possible with any of the conditions listed above, as well as after heavy physical activity or at high temperatures. In this case, the doctor may prescribe a second urine test on another day. It will then be seen if there is still blood in the urine.If so, other tests will be ordered to determine the cause.

    Home care

    Observe the following recommendations for home care:

    • If there is no visual blood in the urine (urine is not pink, brown or red), you do not need to limit your activity in any way.

    • If you see blood in your urine, you need to be calm and not physically exert yourself until your next doctor’s examination. Do not take aspirin, blood thinners, anti-platelet, or anti-inflammatory medicines.These drugs also include ibuprofen and naproxen. They thin the blood and can cause increased bleeding.

    Follow-up

    Come back for your follow-up appointment or as directed by your doctor. If you have blood in your urine after an injury, you should re-take a urine test after 1–2 days. See your doctor for this test.

    If radiographs have been taken, they should be seen by a radiologist.You will be told if these results may affect your treatment.

    When to seek medical attention

    In the following cases, you should immediately contact your healthcare provider.

    • Bright red blood or blood clots in the urine (if not previously)

    • Weakness, dizziness, or fainting

    • Pain in the groin, abdomen or back

    • Temperature 100 , 4 ° F (38 ° C) or higher, or as directed by your healthcare practitioner.

    • Repeated vomiting

    • Bleeding of gums and nose or frequent bruising

    .