I had a urine test 1/3/19 that showed blood in
Questions so that I can advise
Hello Mr. Larson,
Were you having any symptoms at the time that you had the large amount of blood in your urine?
Unless there is an obvious cause for the bleeding (infection, stones), hematuria in a man always needs to be followed up.
I see that you had a CT done, what was the CT done of - abdomen? pelvis? both?
What other urinary tract work up have you had done so far - blood level of creatinine? urine for creatinine?
Were you dehydrated when you had the first urine test? What is your blood sugar?
Hello Mr. Larson,
I am glad that what sounds like a pelvic and abdominal CT were done as painless hematuria in a man always needs to be evaluated.
First I'll address the other information you provided, and then talk a bit about painless hematuria:
1. HDL Cholesterol of 40 mg/dL: on most lab reference ranges, this would fall at the lower end of normal. HDL is the "good" cardioprotective blood lipid.
2. Serum Creatinine of 1.17 is within normal limits, as you indicated. My reason for asking about that is that creatinine can generally be used as an indicator of kidney function.
3. Urine creatinine is not generally performed unless there is a problem, and then a 24 hr urine creatinine is measured.
4. Urinary ketones: The reason I asked if you might have been dehydrated is that fasting, low carb diets, and strenuous exercise can cause ketones to show up in the urine but so can diabetes. However, you have negative glucose in the urine and not out of range on the metabolic panel, so I don't think that is an issue.
5. Trace protein in the urine: generally this is not an issue but with the presence of blood, it is important to follow up on and I see that you mentioned it was not in the follow-up sample.
Now, about painless hematuria: There are a number of things that can cause painless hematuria in a man. Most common are inflammatory processes anywhere along the urogenital tract, including prostatic hypertrophy (enlarged prostate) and urinary tract stones.
Infections can also cause this, but signs of infection should have shown up on the urinalysis. Occasionally there can be a structural abnormality (such as with abnormal blood vessels) but this is less common.
The one that is most concerning of course is the possibility of any malignancy, and the CT-scan will help with sorting that out. But it is a less common cause of hematuria.
Some medications can cause it. And the most benign cause is strenuous exercise. We don't know for sure why strenuous exercise can sometimes cause hematuria - might break down of muscle cells or dehydration, but we don't know for sure the mechanism behind that.
But unless a cause is obvious, it's important to look into the cause of painless hematuria in a man. So the doctor did the right thing by having you get the CT. Now to wait and see the results.
There are some situations where men have painless hematuria and no cause is ever found. In this case, people are just "followed" over time with regular checks.
Will be happy to answer further questions
I'll be happy to provide more information if you have questions once your CT is read.
Bonnie Berger-Durnbaugh, MD
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