The presence of blood in the urine, known as hematuria , can be a sign of various medical conditions, some mild and others more serious. There are two main types of hematuria from a symptomatic point of view: macrohematuria (visible to the naked eye) and microhematuria (not visible to the naked eye and only detected through urinalysis).
In cases of hematuria, the doctor will perform a physical examination and take a medical history. Subsequently, an ultrasound and urine culture will be performed. In most cases, these tests will be sufficient. However, once a clear diagnosis has been established after these examinations, further tests will be conducted, such as an abdominal CT scan, cystoscopy if bladder cancer is suspected, urine cytology to detect possible cancerous cells, blood tests to check kidney function, and a kidney biopsy if glomerular damage is detected, among others.
Causes of hematuria
The causes of hematuria depend largely on gender and age. In men over 40, it is usually due to prostate problems, followed by urinary lithiasis (stones), and then bladder cancer. In women, the main causes are urinary tract infections, kidney or ureter stones, and bladder cancer, especially since tobacco use has become more widespread among women.
Based on an anatomical criterion, hematuria can originate in the following organs:
- Blood of renal or systemic origin: When bleeding originates in the kidney or throughout the body due to high blood pressure or medication, it promotes blood loss through the nephron (the basic structural and functional unit of the kidney responsible for filtering blood). Kidney trauma, intense physical exercise, and some rare kidney diseases such as glomerulonephritis (inflammation of the kidney's small filters) or Berger's disease (a kidney disease that occurs when an antibody called Immunoglobulin A accumulates in the kidneys) can cause blood in the urine.
- Blood of ureteral origin: The bleeding originates in the ureters (tubes that carry urine from the kidneys to the bladder), primarily due to a condition of lithiasis (kidney stones). Likewise, some tumors of the urothelium (the layer of tissue that covers the urethra, bladder, ureters, prostate, and renal pelvis) can cause bleeding.
- Blood of bladder origin: when the blood comes from the bladder because urinary infectionpresence of bladder stones or bladder tumor.
- Blood of prostatic origin: la benign prostatic hyperplasia and prostatitis They are one of the main causes of blood in the urine. Also, although less frequent, the prostate cancer It can also cause hematuria.
- Blood of urethral origin: Some injuries to the urethra (the tube that carries urine from the bladder to the outside of the body) can cause bleeding, but this bleeding does not mix with the urine; it occurs independently of urination. This is called urethrorrhagia (no hematuria), which is bleeding from the urethra that occurs as a trickle, a heavy and continuous stream, or a clot (in this case, it is usually eliminated by straining during urination) due to bladder catheterization injury, the use of urinary instrumentation, a pelvic fracture, or trauma to the penis.
What should I do if I have blood in my urine?
If you detect blood in your urine, it's important to consult your doctor. Hematuria should always be investigated, even if the blood is minimal or appears only once.
Although most of the time the presence of blood in the urine does not translate into any serious problem, there are some cases in which hematuria brings with it potentially dangerous diseases or situations that should be diagnosed as soon as possible.
Treatment of hematuria
Once the origin of the hematuria is discovered, the appropriate treatment can be carried out to cure the disease that is causing it.
Few cases of hematuria require intervention to stop the bleeding, but when this happens, it is necessary to place a three-lumen bladder catheter for irrigation and washing of the bladder.
A blood test will also be necessary to determine if anemia is present, and in exceptional cases, red blood cell concentrates will be required to be transfused.
