| Hematuria is the presence of red blood cells in the urine. The red blood cells may not be detectable by the naked eye, but examination under a microscope shows a high number of red blood cells (microscopic hematuria). Gross hematuria can be easily seen; the urine is red or the color of cola.
Hematuria is a symptom alerting the physician to an underlying condition or disease. Most causes are not serious; many are listed below in Differential Diagnosis.
Hematuria occurs when blood enters the urine from any point along the urinary tract, that is, from the kidney filtering capillaries (glomeruli, see below) to the urethral opening. One of the most common causes of hematuria is an infection that causes inflammation in the urethra (urethritis), bladder (cystitis), or kidneys (pyelonephritis). An inflammation of the prostate gland (prostatitis) or benign prostate enlargement (benign prostatic hypertrophy, or BPH) can cause hematuria in men. Glomerulonephritis, an inflammation of the glomeruli (filtering units in the kidney), can also cause blood in the urine. Other causes of hematuria include cysts, tumors, kidney or bladder stones, trauma (injury), or bleeding disorders. Occasionally, excessive high-impact exercise such as jogging can cause hematuria.Incidence and Prevalence: The overall prevalence of hematuria is about 9% in women and 6% in men. |
Source: Medical Disability Advisor
| History: The individual may report seeing blood in the urine or experiencing pain on urination. A fever, rash, or lower abdominal pain may also be present. Frequent urination may later change to urinary retention. Recent trauma to the abdomen, back, or flank may be reported. Physical exam: The blood may be clearly visible as the urine comes out red; small amounts of blood may give the urine a cloudy or smoky appearance; or blood may not be visible at all except under a microscope. Fever, rash, or elevated blood pressure (hypertension) may be present. A mass in the abdomen or pelvic region may be apparent upon applying pressure to the abdominal area (palpation). Tests: Diagnostic tests should include a urinalysis and urine culture. Urine samples should be carefully collected in sequential portions (known as aliquots) to help isolate the potential source of bleeding. For example, hematuria in the first voided aliquot indicates that the bleeding may originate from the urethra and/or the prostate. In addition to red blood cells, a urinalysis may reveal white blood cells indicative of a urinary tract infection. An analysis of chemical components may reveal excess protein, which may be a sign of poor kidney function. Casts (groups of cells molded together in the shape of the kidneys' tiny filtering tubes) can signal kidney disease. High levels of wastes usually excreted by the kidneys (filtered out from the blood) through the urine may be detected by analyzing a blood specimen and is additional evidence of kidney disease.
The presence of cysts, stones, or tumors can be detected through images of the urinary tract using ultrasound or CT scan. Intravenous pyelography (IVP) follows the route of a dye through the urinary tract using x-ray imaging and gives important information about the kidneys, ureters, and bladder. Angiography is a procedure that enables the vessels in the kidneys to be seen on film after they have been filled with a substance that shows up on x-ray (contrast medium). Direct examination of the bladder and ureters may be achieved using a fiber-optic instrument inserted through the urethra (cystoscopy and ureteroscopy). |
Source: Medical Disability Advisor
| Hematuria or blood in the urine is a symptom rather than a diagnosis. Treatment is determined by the underlying condition. In many cases, the underlying cause is not serious, and no treatment is necessary. An antibiotic is used if the hematuria is due to an infection. |
Source: Medical Disability Advisor
| Since hematuria is a symptom, not a diagnosis, the outcome depends on the underlying condition and its response to treatment. Most causes of hematuria either require no treatment or are easily treatable. However, hematuria may be indicative of a more serious condition such as kidney disease or cancer of the bladder, prostate, or kidney. |
Source: Medical Disability Advisor
| Potential complications are determined by the underlying condition. |
Source: Medical Disability Advisor
| Work restrictions or accommodations will be specific to the diagnosis and subsequent treatment of the underlying condition. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Is individual a runner or jogger?
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Is there a history of a bleeding disorder? Trauma to the urinary system? Prostate enlargement? Infection in the prostate, bladder, or kidneys? Glomerulonephritis?
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Was a microscopic examination done of the urine?
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Has individual had any pain with urination?
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Has individual had any recent trauma to the abdomen or lower back?
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Is fever, rash, or lower abdominal pain present?
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Was a urinalysis and urine culture done?
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Were tests done to rule out kidney disease?
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Did individual have imaging tests to rule out cysts, stones, tumors, or abnormalities in the blood vessels of the kidneys?
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Did individual have a cystoscopy and ureteroscopy?
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Were conditions such as cystitis, urethritis, pyelonephritis, prostatitis, cysts, tumors, kidney or bladder stones, glomerulonephritis, trauma, or bleeding disorders ruled out?
Regarding treatment:
- Has the underlying cause of the hematuria been accurately diagnosed?
Regarding prognosis:
- What is the underlying condition?
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Has there been sufficient time to heal from trauma?
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Have job requirements been modified?
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Source: Medical Disability Advisor
| Walsh, Patrick C., et al., eds. Campbell’s Urology. 8th ed. 4 vols. Philadelphia: W.B. Saunders, 2002. MD Consult. Elsevier, Inc. 20 May 2005 <http://home.mdconsult.com/das/book/47361886-14/view/1049?sid=368889547>. |
Source: Medical Disability Advisor
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