HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

question-icon

What Causes Hematuria?

default
Posted on Wed, 21 May 2014
Question: Several times in the past week I,ve noticed that my urine turned the water in the stool a dark XXXXXXX .. In between there is only a light or no color. I have been doctoring for almost two years for pain in my left side sometimes in the back and at times the front.. I do have some back problems so every doctor suggests the pain is from my back, however it doesn't feel like back pain... I had an ultra sound in Feb of 2012 that showed "a 3mm echogenic focus in the lower pole of the left kidney likely a tiny calculus"and some blood work that was off, but no true diagnosis. A CT done a bit later did not show it.. I was sent to a urologist I assume due to the fact that my blood work was off, who said in the report the I had stage 2/3 kidney disease, and made another appt. for a yr. later. Now I am seeing this dark urine and wondering if I should be concerned... What would cause this what I assume to be blood?
doctor
Answered by Dr. Shafi Ullah Khan (2 hours later)
Brief Answer:
Hematuria a sign not disease need workup & consult

Detailed Answer:
Thank you for asking!
Hematuria has multiple etiologies and needs a little workup and management to sort out the cause. You have geriatric age limits and a history of rheumatological conditions which themselves are great trigger for nephropathy. Here are some possibilities for hematuria which are mostly divided into either glomerular or extra glomerular cause.
The first step in the evaluation of hematuria consists of a detailed history and a thorough physical examination. Efforts should be made to distinguish glomerular causes from extraglomerular ones, as follows:

Passage of clots in urine suggests an extraglomerular cause
Fever, abdominal pain, dysuria, frequency, and recent enuresis in older children may point to a urinary tract infection as the cause
Recent trauma to the abdomen may be indicative of hydronephrosis
Early-morning periorbital puffiness, weight gain, oliguria, dark-colored urine, and edema or hypertension suggest a glomerular cause
Hematuria due to glomerular causes is painless
Recent throat or skin infection may suggest postinfectious glomerulonephritis
Joint pains, skin rashes, and prolonged fever in adolescents suggest a collagen vascular disorder
Anemia cannot be accounted for by hematuria alone; in a patient with hematuria and pallor, other conditions should be considered
Skin rashes and arthritis can occur in Henoch-Schönlein purpura and systemic lupus erythematosus
Information regarding exercise, menstruation, recent bladder catheterization, intake of certain drugs or toxic substances, or passage of a calculus may also assist in the differential diagnosis
A family history that is suggestive of Alport syndrome, collagen vascular diseases, urolithiasis, or polycystic kidney disease is important
Physical examination should include the following:

Measurement of the blood pressure (with an appropriately sized cuff)
Evaluation for the presence of periorbital puffiness or peripheral edema
Detailed skin examination to look for purpura.
Abdominal examination to look for palpable kidneys
Careful examination of the genitalia
Detailed ophthalmologic evaluation (in familial hematuria)
The following findings help distinguish between glomerular and nonglomerular hematuria:

Glomerular hematuria: Brown-colored urine, RBC casts, and dysmorphic (small, deformed, misshapen, sometimes fragmented) RBCs and proteinuria
Nonglomerular hematuria: Reddish or pink urine, passage of blood clots, and eumorphic (normal-sized, biconcavely shaped) erythrocytes

You need a little work up and management accordingly.
Here are some of the management plans for hematuria
Hematuria is a sign and not itself a disease; thus, therapy should be directed at the process causing it
Asymptomatic (isolated) hematuria generally does not require treatment
In conditions associated with abnormal clinical, laboratory, or imaging studies, treatment may be necessary, as appropriate, with the primary diagnosis
Surgical intervention may be necessary with certain anatomic abnormalities (eg, ureteropelvic junction obstruction, tumor, or significant urolithiasis)
Dietary modification is usually not indicated, except for children who may tend to develop hypertension or edema as a result of the primary disease process (eg, nephritis)
Patients with persistent microscopic hematuria should be monitored every 6-12 months for the appearance of signs or symptoms indicative of progressive renal disease

I hope it helps. Seek a rheumatologist and let them sort it out for you.Hematuria itself is not a disease rather an emblem of underlying one. Lets wait for the appointment and hope for the best.
It needs a complete clinical correlation to establish a diagnosis here.
I hope you see it in a right perspective. Seek a nephrologist and urologist and let a complete renal functional profile be assessed.
Take care of yourself and dont forget to close the discussion please.
Regards
S Khan
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3613 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
What Causes Hematuria?

Brief Answer: Hematuria a sign not disease need workup & consult Detailed Answer: Thank you for asking! Hematuria has multiple etiologies and needs a little workup and management to sort out the cause. You have geriatric age limits and a history of rheumatological conditions which themselves are great trigger for nephropathy. Here are some possibilities for hematuria which are mostly divided into either glomerular or extra glomerular cause. The first step in the evaluation of hematuria consists of a detailed history and a thorough physical examination. Efforts should be made to distinguish glomerular causes from extraglomerular ones, as follows: Passage of clots in urine suggests an extraglomerular cause Fever, abdominal pain, dysuria, frequency, and recent enuresis in older children may point to a urinary tract infection as the cause Recent trauma to the abdomen may be indicative of hydronephrosis Early-morning periorbital puffiness, weight gain, oliguria, dark-colored urine, and edema or hypertension suggest a glomerular cause Hematuria due to glomerular causes is painless Recent throat or skin infection may suggest postinfectious glomerulonephritis Joint pains, skin rashes, and prolonged fever in adolescents suggest a collagen vascular disorder Anemia cannot be accounted for by hematuria alone; in a patient with hematuria and pallor, other conditions should be considered Skin rashes and arthritis can occur in Henoch-Schönlein purpura and systemic lupus erythematosus Information regarding exercise, menstruation, recent bladder catheterization, intake of certain drugs or toxic substances, or passage of a calculus may also assist in the differential diagnosis A family history that is suggestive of Alport syndrome, collagen vascular diseases, urolithiasis, or polycystic kidney disease is important Physical examination should include the following: Measurement of the blood pressure (with an appropriately sized cuff) Evaluation for the presence of periorbital puffiness or peripheral edema Detailed skin examination to look for purpura. Abdominal examination to look for palpable kidneys Careful examination of the genitalia Detailed ophthalmologic evaluation (in familial hematuria) The following findings help distinguish between glomerular and nonglomerular hematuria: Glomerular hematuria: Brown-colored urine, RBC casts, and dysmorphic (small, deformed, misshapen, sometimes fragmented) RBCs and proteinuria Nonglomerular hematuria: Reddish or pink urine, passage of blood clots, and eumorphic (normal-sized, biconcavely shaped) erythrocytes You need a little work up and management accordingly. Here are some of the management plans for hematuria Hematuria is a sign and not itself a disease; thus, therapy should be directed at the process causing it Asymptomatic (isolated) hematuria generally does not require treatment In conditions associated with abnormal clinical, laboratory, or imaging studies, treatment may be necessary, as appropriate, with the primary diagnosis Surgical intervention may be necessary with certain anatomic abnormalities (eg, ureteropelvic junction obstruction, tumor, or significant urolithiasis) Dietary modification is usually not indicated, except for children who may tend to develop hypertension or edema as a result of the primary disease process (eg, nephritis) Patients with persistent microscopic hematuria should be monitored every 6-12 months for the appearance of signs or symptoms indicative of progressive renal disease I hope it helps. Seek a rheumatologist and let them sort it out for you.Hematuria itself is not a disease rather an emblem of underlying one. Lets wait for the appointment and hope for the best. It needs a complete clinical correlation to establish a diagnosis here. I hope you see it in a right perspective. Seek a nephrologist and urologist and let a complete renal functional profile be assessed. Take care of yourself and dont forget to close the discussion please. Regards S Khan