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more articles by Hesson, Robert A , MD  |  author's bio

Don’t Take a “Wait and See” Attitude With Blood In The Urine

Don’t Take a “Wait and See” Attitude with Blood in the Urine

Causes, diagnosis, and treatment of urinary tract infections

By Robert A. Hesson, M.D., F.A.C.P.

Did you know that your kidneys require 20 percent of your total blood flow to function effectively? They are part of the urinary tract and they perform a number of crucial functions. The kidneys act as a filter to eliminate toxic waste from the blood, control the body’s acid-alkaline balance, regulate your blood pressure, and produce a number of important hormones. In fact, the only organs that use and circulate more blood are your heart, lungs, and brain.

One of the ways in which our kidneys indicate a problem is by the appearance of blood in the urine. And while blood in the urine is a relatively common occurrence, it is always an indication that something is wrong. If you notice blood, make an appointment to see your doctor because this is not one of those instances where a “wait and see” attitude is the right approach. There may be significant pathology, including infections that require medical intervention. Those problems always need to be ruled out before a period of observation is reasonable.

What are the common causes of blood in the urine?

Among women, the most common cause of blood in the urine is a urinary tract infection (UTI). In men, the most common causes are an enlarged prostate (the gland that surrounds the neck of the bladder and the urethra) and prostate cancer.

Other causes range from insignificant to serious. Some families, for example, have a genetic condition known as benign familial hematuria where there is a natural tendency to put blood into the urine, and it is of no consequence. On the other hand, blood can indicate very serious conditions like bladder cancer or a primary kidney disease that has inflamed the kidney. Sometimes blood in the urine indicates other underlying problems like infected heart valves or autoimmune diseases, such as lupus.

Someone who has been hit hard in a contact sport may have suffered a bruised kidney which can put blood in the urine temporarily. Even then you should be checked out by a doctor because there may well be an underlying condition that caused you to bleed under contact. Whenever there is blood in the urine it is very important to your health and well-being to determine why it is there.

How are these problems diagnosed?

The earliest portion of the medical evaluation may be done by your primary care physician to either treat or rule out UTI, which is a commonplace problem that generally responds well to appropriate antibiotics. If the blood is not a result of UTI, you may need to see a urologist to rule out anatomic problems like kidney stones or cancer of the bladder, kidney, or prostate.

At this stage, evaluation of these problems often includes radiologic imaging of the kidneys, using a dye and x-ray, CT scan, MRI scan, or ultrasound. Your doctor may recommend a cystoscopy, which is a diagnostic procedure that allows the doctor to look directly into the bladder. If she or he sees no sign of pathology, you may be referred to a nephrologist to look for kidney disease or other serious problems that produce blood in the urine. The ultimate goal is to identify the underlying cause so it can be treated.

Sometimes blood in the urine produces symptoms that feel just like a UTI. Often people are thought to have had multiple UTIs, when in fact the symptoms they have been suffering came from the existence of blood in the urine but were not, in fact, caused by a UTI. If you believe you have had multiple UTIs, you may require a catheterized urine sample to end the confusion and to avoid contaminating the urine sample with other normally occurring bacteria on your body.

Dr. Hesson is board certified in internal medicine and nephrology and serves on the medical staff at Cayuga Medical Center. His practice is located in the professional building adjacent to the Medical Center.

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