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Blood in urine may or may not be accompanied by pain, but is always abnormal and should be further investigated. The medical term for the presence of red blood cells in the urine is hematuria. Visible blood in the urine is referred as gross hematuria, while blood in the urine that is not visible to the naked eye is referred to as microscopic hematuria. When there is enough blood to be visible, the urine may look pinkish, red, smoky brown (like tea or cola). Color of blood also denotes whether it is fresh (pink or red) or old blood (cola colored).

Causes of Blood in Urine
  • Any condition that result in infection, inflammation or injury to the urinary system (kidney, ureter, bladder or prostate) may result in hematuria
  • The most common cause in people younger than 40 years of age are kidney stones or urinary tract infection
  • Cancers of the kidney, bladder and prostate become a more common concern in people older than 40 years of age.

When to Seek Medical Care

Any episode of blood in urine with or without other symptoms of urinary tract disease should be investigated

Examination and Tests: After the initial physical examination, following laboratory and imaging studies may help in reaching the diagnosis

  • Urine ‘dipstick’: This test can be done in doctor’s office or emergency department. A strip of chemically treated paper is dipped into a cup containing a sample of urine. The paper will show different colors to indicate the presence of blood, protein, glucose or infection.
  • Urinalysis: In this test, the urine sample is examined under a microscope to look for red blood cells and white blood cells (which signify infection)
  • Urine culture: It is the test to detect and identify organisms (usually bacteria) that may be causing a urinary tract infection (UTI)
  • Urine Cytology: In the absence of stones or infection, hematuria in anyone 40 years of age or older should be investigated to determine if cancer is present in the urinary system. In this test, a pathologist examines a fresh sample of urine under the microscope for any abnormal cell from the urinary tract.

Imaging:
  • Ultrasound: It is usually the first imaging study to perform because it is simple, safe and widely available. It serves as a screening test to look for kidney enlargement, stone, cancer, prostate enlargement and narrowing of the urinary tract.
  • CT scan: It uses X rays but gives much better details. The test can be performed with or without contrast agents. It is an excellent investigation for detecting stones in the urinary system. It is also done to evaluate anyone 40 years of age or older in case the suspicion for presence of cancer is high.

Procedures:
  • Cystoscopy: This test is performed by a specialist dealing with the urinary system (Urologist). In this procedure, a thin tube with a tiny camera on its end (Flexible Cystoscope) is passed into the urethra (lower most part of urinary tract) to visualize the bladder, prostate (in men), and ureters. If required, small pieces (biopsy) of suspicious areas can also be taken for microscopic examination.

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