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Blood in the Urine (Hematuria)

  • The presence of red blood cells in urine
  • Symptoms include urine that turns pink, red, or brown
  • Treatment is typically antibiotics and if there is some defect, possibly surgery
  • Involves urology, urologic oncology

Overview

Noticing bloody or discolored urine, a condition known as hematuria, can be alarming. In most cases, your doctor will refer you to a urologist for further examination.

"As urologists, we are often tasked with discovering the source of blood in the urine," says Joseph Brito, MD, a Yale Medicine urologist, practicing at Lawrence and Memorial Hospital in New London. "Though this can occasionally be related to benign causes, blood in the urine should never be considered normal," he says.

Although there are harmless causes of hematuria, including heavy exercise, infection, kidney stones, or trauma to the urinary tract, it’s important to know that hematuria is often the only sign of an underlying malignancy (cancer) such as a tumor in the bladder or kidney. 

“Even if you notice blood in the urine on a single occasion, it should not be ignored,” urges Dr. Brito. At Yale Medicine's Department of Urology, doctors recommend that patients schedule an appointment whenever they notice blood in the urine. Swift and accurate diagnosis allows for timely treatment for any underlying issue and also offers patients peace of mind.

What is hematuria?

Hematuria is the presence of red blood cells in the urine. When blood in the urine is visible to the naked eye (usually causing urine to turn tea-colored), it’s called gross hematuria. When red blood cells are present in a patient’s urine but not visible, it's called microscopic hematuria. Both conditions are considered potential indicators of a health problem. Blood in the urine can originate from any portion of the urinary tract—from the kidneys to the urinary opening (urethra).

What are the risk factors for hematuria?

Hematuria occurs in children, teens and adult men and women. Some of these factors that may increase the risk of blood in the urine:

  • Family history: Members of families with a history of kidney stones or kidney disease have a greater risk for having hematuria.
  • Infections: When children are diagnosed with hematuria, it can often be linked to recent viral or bacterial infections of the kidneys.
  • Strenuous exercise: Hematuria can be associated with strenuous activities like long-distance running. This condition is sometimes called "jogger’s hematuria."
  • Certain medications: Medications that might cause hematuria include aminoglycosides, cyclophosphamide (Cytoxan), amitriptyline, diuretics, analgesics, oral contraceptives, anticonvulsants, penicillins (extended spectrum), quinine (QM-260), busulfan (Busulfex), vincristine (Oncovin), and chlorpromazine (Thorazine).
  • Anticoagulant prescriptions: Some blood thinners can make hematuria more pronounced. Such medications include warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto), and clopidogrel (Plavix).

Consuming large amounts of beets may cause the urine to appear bloody, even though it is not. This is known as pseudohematuria.

What are the symptoms of hematuria?

Patients may notice that their urine has changed color. Commonly a patient's urine will turn pink, red or brown. Hematuria can be associated with other symptoms depending on the cause. Urologists often distinguish between painful and painless causes of hematuria. Microscopic hematuria, which is detected on a urine analysis test, is often asymptomatic.

How is hematuria diagnosed?

Physicians will run the proper tests to make an accurate diagnosis. Common tests include:

  • Urinalysis: Laboratory examination of urine may reveal various cells and chemicals, such as red blood cells, white blood cells, infection or excessive protein.
  • Blood tests:  Laboratory examination of blood may reveal high levels of waste products, indicating kidney dysfunction.
  • Cystoscopy: Also called cystourethroscopy. A scope, a flexible tube and viewing device, is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.
  • CT or MR urogram: A series of images obtained with IV contrast focused on the abdomen and pelvis to evaluate the urinary tract. This is done to detect tumors, abnormalities, kidney stones or any obstructions, and to assess renal blood flow.
  • Renal ultrasound: A test utilizing sound waves to evaluate the size, shape and contour of the kidneys and urinary-collecting system.

How is hematuria treated?

Because hematuria is a possible indicator of a health issue and not a disease itself, treatment will depend on an accurate diagnosis. By performing diagnostic tests, doctors can determine the source of bleeding.

If due to an infection, a simple course of antibiotics may be the cure. If the problem is with the kidneys themselves, patients may be referred to a nephrologist for further management. If a malignancy or anatomic defect is the cause, surgery may be recommended. If it is determined that hematuria is from a benign cause, treatment may not be necessary.

What makes Yale Medicine’s approach to treating hematuria unique?

"Many causes of hematuria are not serious, but that doesn’t mean we don’t take every case seriously,” says Dr. Brito.

At Yale Medicine Department of Urology, we examine each patient with hematuria for related problems, including tumors, kidney disease, infections or injury. "While each patient is unique, we treat every case of hematuria with the same high index of suspicion,” he says. “Connecticut and Rhode Island are both in the top five states per capita for bladder cancer incidence, so any warning signs should be taken seriously.”  

Yale Medicine’s state-of-the-art imaging capabilities, expertise in radiology and pathology, and the use of molecular diagnostic tests set our team apart from many community centers.