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Hematuria

Hematuria is the presence of red blood cells (RBCs) in the urine. Often, the urine appears normal to the naked eye, but examination under a microscope shows a high number of RBCs. In gross hematuria, the urine is red or the color of cola, which can be seen with the naked eye.

Causes

• Prolonged exercise, such as a running a marathon, with no underlying disease (benign hematuria).
• Kidney disease.
• Kidney, ureter, bladder or urethral injury.
• Stone in the ureter, kidney or bladder.
• Infection.
• Tumor of the urinary tract.

Signs and symptoms

• Bloody urine with many red blood cells present (gross hematuria).
• "Smoky" colored urine. Red blood cells are visible in large quantities when urine is examined under the microscope (microscopic hematuria). Clear urine may also contain some red blood cells that are visible under the microscope.

Additional symptoms in athletes that indicate the need for laboratory studies of the kidneys:

• Discomfort, frequency or urgency in urinating (may represent infection).
• Colicky pain in either flank (area on the side of the abdomen under the last rib).
• Hematuria lasting longer than 48 hours after exercise.
• Decreased urine output for 12 hours after prolonged, strenuous exercise.

Diagnosis

There are a number of tests that, when combined with a physical examination and medical history, will help your doctor make an accurate diagnosis. These can include a simple urine dipstick test that detects the presence of blood, a urine culture that shows up any infection, blood chemistry tests that will demonstrate, amongst other things, kidney function. Microscopic examination may detect cancer cells.

IVP: an intravenous pyelogram, is an X-ray test where a dye containing iodine is tracked on its journey through the genito-urinary system showing up any abnormalities.
Cystoscopy: a flexible fibre optic tube can be introduced so that the doctor can see any abnormalities may require treatment.
Ultrasound and CAT: (computer assisted tomography) may be required for further investigation if the above tests fail to find a cause.

Treatment

Treatment is dictated by cause, so may comprise, for example, antibiotics, surgery or medication review. Treatment ranges from antibiotic therapy to surgery, depending on the underlying cause.

Many causes of hematuria are not serious and, in some cases, exercise can cause hematuria to go away within a day. It is important to consult your physician since hematuria may result from a tumor or other serious problem.

Prevention

• Obtain treatment for any illness of the kidney or urinary tract.
• Don't get dehydrated. Drink lots of water-a minimum of 8 glasses per day-and much more during hot weather and prolonged exercise.
• Include urine studies in your routine checkups every 2 to 3 months during periods of vigorous activity.