Microscopic Hematuria – familydoctor.org

What is microscopic hematuria?

Microscopic hematuria is blood in the urine. “Microscopic” means something is so small that it can only be seen through a special tool called a microscope. So, if you have microscopic hematuria, you have red blood cells in your urine that can’t be seen with the naked eye.

Symptoms of microscopic hematuria

Most of the time, you won’t have symptoms of microscopic hematuria. Sometimes you may feel a burning sensation when you urinate. Or you may feel the urge to urinate more often than usual.

What causes microscopic hematuria?

Many times, there is no cause for microscopic hematuria. It comes and goes on its own. Other times, it may be caused by:

• Kidney infections
• Enlarged prostate
• Urinary tract (bladder) infection
• Swelling in the filtering system of the kidneys. This is called “glomerulonephritis.”
• A stone in your bladder or in a kidney
• A disease that runs in families, such as cystic kidney disease
• Some medicines
• A blood disease, like sickle cell anemia
• A tumor in your urinary tract (may or may not be cancer)
• When this is the cause, hematuria will usually go away in 24 hours.

How is microscopic hematuria diagnosed?

Your doctor will usually start by asking you for a urine sample. They 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 intravenous pyelogram. This is like an X-ray that looks at your kidneys and bladder
• A special tool, such as a cytoscope or an endoscope, may be used to look inside your bladder. This type of test is usually done by a special doctor called a urologist.

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. If you are menstruating, tell your doctor before you give your urine sample.

• 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.

Can microscopic hematuria be prevented or avoided?

You may not be able to prevent microscopic hematuria, depending on what causes it. But the Centers for Disease Control and Prevention recommends drinking plenty of fluids, especially when you’re exercising.

Microscopic hematuria treatment

If your doctor finds what’s causing the blood in your urine, they will treat that problem. Later, they will check your urine again to see if the blood is gone. If it’s not, your doctor may perform more tests or refer you to a urologist.

Living with microscopic hematuria

If you have no symptoms of microscopic hematuria, you may not know to alert your doctor. But if you do have symptoms, call your doctor right away. It is always important to find out the cause of blood in your urine.

Questions to ask your doctor

• What is causing the blood in my urine?
• Could I have a kidney stone?
• What treatment is best for me?
• Are there any medicines that I can take for this problem?
• Will I need surgery?
• How often do I need to come back for a follow-up visit?
• Could I have cancer?

Resources

National Institute of Diabetes and Digestive and Kidney Diseases: Hematuria (Blood in the Urine)

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

What does trace-intact blood in urine mean?

A 33-year-old member asked:

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Need workup

: Trace blood in urine means you will need a repeat urinalysis and then a workup by a urologist if this is confirmed with microscopic examination of urine to have 3 or more red blood cells per high power field. If you have this amount or more of red blood cells, you will need a urine culture, cytology, imaging (ct scan), and cystoscopy=camera to look inside the bladder. See your urologist.

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Similar questions

A 32-year-old member asked:

What does it mean if you have a trace of occult blood in urine?

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Runs the gamut…

: The fact that it is a trace amount is the best news – just keep an eye on it. The fact that there is blood in your urine may indicate kidney stone, infection, prostate cancer, or the simple act of running or driving daily and causing the minor bouncing trauma of those activities that cause your kidneys to leak a little blood. Could be something, could be nothing. Something to follow, though.

5.2k viewsAnswered >2 years ago

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A 42-year-old member asked:

What does a trace of blood in urine mean?

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Dr. Jack Rubinanswered

Nephrology and Dialysis 50 years experience

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Hematuria

: If you have hematuria (h), you need to find its cause. First have a urine culture to see if you have a uti. If not, see a urologist (u) for an evaluation of the h. The u will order a renal ultrasound and an ivp to assess the state of your kidneys. If those tests are negative, a cystoscopy, to see the bladder wall, may be needed. If you don’t have a uti, see a u to find the cause of it. Good luck.

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A 36-year-old member asked:

What does trace of occult blood in urine mean?

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Dr. Eric Kaplananswered

Colon and Rectal Surgery 44 years experience

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It means

: That altho no visible blood, chemically blood was detected in your urine. This is not usually normal. You may have an infection or a ureteral/kidney stone or some bladderinflammation or a tumor, so please get evaluated, diagnosed and properly treated.

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Need more tests

: Specifically, you need to have a urinalysis and urine culture by your doctor. If on two urinalyses, there are 3 or more red blood cells per high per field under microscope, then you will need a full workup. The workup includes urinecytology, imaging (ctscan usually), and camera to look inside the bladder (cystoscopy).

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A 39-year-old member asked:

What does small traces of blood in urine without an infection mean?

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Blood in urine

: If only a trace amount of blood (without any protein in urine), the most likely possibilities include kidney stones or crystals in the urine, recent heavy exercise, thin basement membrane nephropathy, or IgA nephropathy. The latter 2 are detected with a kidney biopsy, but in the absence of protein in the urine most nephrologists would not pursue one. Also need to consider a kidney or bladder mass.

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NJ

A 42-year-old female asked:

What does it mean when you have traces of blood in urine? How can that go away? How dangerous is it???

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Blood in urine

: Blood in the urine is not normal and should be evaluated. Possible causes include infection, stones, blood disorders, trauma and tumors. Sometimes, urine dipstick tests are very sensitive and will register “trace” blood, and the result may not be clinically significant. Your doctor can help sort this out.

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Last updated Jun 8, 2021

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Blood in the urine (hematuria). Causes of hematuria

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Blood in the urine is a warning sign. In the language of medicine, blood in the urine is called hematuria . There are gross hematuria , when the presence of blood in the urine can be detected with the naked eye, and microhematuria , when blood can only be detected during a laboratory test.

Causes of hematuria

Blood can enter the urine at any stage of the formation and excretion of urine, so hematuria can be a sign of damage to any organ of the urinary system – the kidneys, ureters, bladder or urethra. An indication of exactly where the problem is localized can be in which portion of the urine there is blood. If blood is found at the beginning of urination (in the first portion of urine), then the source of bleeding is most likely in the urethra. If blood is present in the last portion (detected already at the end of urination), then the most likely location of the source of bleeding is in the bladder neck or in the upper part of the urethra or (in men) in the prostate gland. If blood is present throughout the entire act of urination, then we should expect that the source of blood is higher – in the kidneys, ureters or bladder.

The main causes of blood in the urine are:

• infectious diseases. Inflammatory processes lead to circulatory disorders. With inflammatory processes in the kidneys and other organs of the urinary system, a small amount of red blood cells (erythrocytes) may be in the urine. As a rule, in this case we are talking about microhematuria. However, in women, one of the most common causes of blood in the urine is cystitis, one of the varieties of which – hemorrhagic cystitis – is characterized precisely by the visible presence of blood in the urine (that is, gross hematuria);
• injuries;
• urolithiasis. The resulting stones injure the organs of the urinary system. In some cases, the appearance of blood in the urine is the reason for the examination and detection of the disease;
• neoplasms;
• glomerulonephritis. With this disease, the functioning of the renal filtration barrier is disrupted. Normally, it should allow water and relatively small molecules of solutes to pass through, preventing blood cells from entering the urine. Glomerulonephritis causes red blood cells to enter the urine. At the same time, microscopy reveals deformation and discoloration of erythrocytes in the urine. This allows you to establish that the cause of the appearance of blood in the urine is precisely glomerulonephritis.

Pregnant women often have idiopathic hematuria (i.e., hematuria whose cause cannot be determined). Such hematuria usually stops after childbirth.

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Blood in the urine: when to see a doctor

When blood appears in the urine, you should definitely consult a doctor. Don’t wait for it to “go away”. Blood in the urine is a fairly serious symptom that may indicate diseases that cannot go away on their own.

Blood in urine: which doctor to contact

If blood appears in the urine, it is necessary to consult a general practitioner (adults – a general practitioner, children should be shown to a pediatrician) or a urologist. Most likely, you will need to pass tests and undergo an ultrasound of the urinary system.

Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

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Hematuria (blood in the urine): causes and treatment

There are many causes of blood in the urine. This condition, known as hematuria, can be a warning sign of a serious illness or be the result of minor changes in the body.

What should you do 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 “gross hematuria”, when blood in the urine is visible to the naked eye, or “microhematuria”, when red blood cells are detected under a microscope in urine tests. Hematuria can originate from anywhere in 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, 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 disease. Studies have shown that 9 to 18 percent of healthy people may have clinically insignificant microhematuria. However, hematuria is often a warning sign for immediate treatment. Below is a list of the most common causes of hematuria:

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

How to detect hematuria?

Visible hematuria often worries patients and makes them see a doctor.

Microhematuria is determined by microscopy of the urine sediment.

What tests are needed to make a diagnosis?

Any patient with gross hematuria or severe microhematuria should have a comprehensive urinary tract evaluation. The first step is a thorough history taking and physical examination. Next, a laboratory analysis of urine and a study of the urinary sediment under a microscope are carried out. Urine is examined for the presence of protein (a sign of kidney disease) and urinary tract infections. The number of erythrocytes in the urine (erythrocyturia), the content of leukocytes in the urine (leukocyturia) is determined. Urinalysis should be done to look for abnormal cells. Laboratory blood tests are done to measure serum creatinine (kidney function tests).

Patients with significant urinary protein or elevated creatinine should undergo further 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 (plain view of the urinary system) to rule out masses and stones. Excretory urography is performed – a method for determining kidney function, based on the introduction of radiopaque drugs into the bloodstream, followed by radiography and the determination of dye excretion by the kidneys. Many clinicians may choose other imaging studies such as computed tomography (CT), multislice computed tomography (MSCT). These methods are preferred and more informative for assessing the condition of the kidneys, and are also the best methods for assessing urinary stones. Recently, many urologists use 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 exposure. In patients with elevated creatinine levels or allergy to radiopaque 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, a radiopaque drug is injected into the kidney through the ureteral catheter, followed by radiography.

Patients with haematuria undergo cystoscopy under local anesthesia using a rigid, or more commonly, flexible instrument called a cystoscope. After anesthesia, a cystoscope is inserted through the urethra into the bladder and the bladder and urethra are assessed for the presence of formations.

What to do if there was or is hematuria, and no causes were found as a result of the examination?

In at least 8-10 percent of cases, no cause for hematuria is 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 were later found to have malignant tumors of the urinary system.

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