What Can Cause Microscopic Blood In Urine – Microscopic hematuria is blood in the urine. “Microscopic” means something so small that it can only be seen with a special instrument called a microscope. So, if you have microscopic hematuria, you have red blood cells in your urine that can’t be seen with the naked eye.

Most of the time, you will not have symptoms of microscopic hematuria. Sometimes you may experience a burning sensation when you urinate. Or you may have an urge to urinate more often than usual.

What Can Cause Microscopic Blood In Urine

Most of the time, there is no reason for microscopic hematuria. It comes and goes by itself. Other times, it may be due to:

Pdf] Assessment Of Asymptomatic Microscopic Hematuria In Adults.

Your doctor will usually start by asking you for a urine sample. They will test your urine (urinalysis) for the presence of red blood cells. Your doctor will also check for other things that might explain what’s wrong. For example, white blood cells in your urine usually mean you have an infection. If you have blood in your urine, your doctor will ask you some questions to find out what’s causing it.

A nurse will give you antiseptic wipes and a sterile urine collection cup to clean yourself. In the bathroom, wash your hands first with soap and warm water. If you are menstruating, tell your doctor before you give your urine sample.

You may not be able to stop microscopic hematuria, depending on the cause. But the Centers for Disease Control and Prevention recommends drinking plenty of fluids, especially when you’re exercising.

If your doctor finds out what is causing the blood in your urine, they will treat that problem. Later, they will check your urine again to see if the blood has passed. If it doesn’t, your doctor may do more tests or refer you to a urologist.

Assessment Of Asymptomatic Microscopic Hematuria In Adults

If you have no symptoms of microscopic hematuria, you may not know to alert your doctor. But if you have symptoms, call your doctor right away. It is always important to find out the cause of blood in your urine.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this topic. In its 2011 recommendation statement, the US Preventive Services Task Force found insufficient evidence for or against screening for bladder cancer in asymptomatic adults. .

Despite this, microscopic hematuria is often found incidentally during routine health examinations, with a prevalence of approximately 2% to 31%.

Because primary care physicians are usually the first to recognize asymptomatic microscopic hematuria, an evidence-based approach to evaluating hematuria is needed. In 2012, the American Urological Association (AUA) published updated guidelines on the diagnosis, evaluation, and follow-up of asymptomatic microscopic hematuria in adults.

Leading Organizations Release Joint Clinical Guideline For Diagnosis And Evaluation Of Microhematuria

Based on guidelines, this article describes current approaches to the diagnosis, follow-up, and referral of patients with asymptomatic microscopic hematuria.

There is insufficient evidence to recommend screening urinalysis for bladder cancer detection in the absence of clinical indicators.

Further evaluation is recommended for individuals with three or more red blood cells per high-power field in a well-collected urine sample in the absence of infection.

Concurrent nephrologic and urologic referral is indicated in the presence of hypertension, elevated creatinine levels, and dysmorphic red blood cells, cellular casts, or proteinuria on urinalysis.

Hematuria Diagnostic Evaluation

Nevertheless, formal evaluation is critical, as malignancies are detected in 5% of patients with microscopic hematuria and in 30% to 40% of patients with gross hematuria.

Studies have found that recommended diagnostic guidelines are rarely followed, resulting in inappropriate and costly referrals, and failure to detect many treatable causes of hematuria.

Although the reasons for lack of adherence to guideline recommendations are unclear, they are likely secondary to a combination of factors, including confusion about the suggested workup, rarity of finding clinically significant etiologies, patient compliance with follow-up, and costs.

Hundreds of diseases have been shown to cause hematuria. In the small percentage of patients for whom an etiology is identified, causes may include urinary tract infection, benign prostatic hyperplasia, medical renal disease, urinary calculi, urethral stricture disease, and urologic malignancy.

Hematuria (blood In Urine)

The risk of urologic malignancy is significantly increased in men, people older than 35 years, and people with a history of smoking.

Table 2 lists other factors that have been shown to increase the risk of urologic malignancy in patients with asymptomatic microscopic hematuria.

Approximately 10 mL of midstream urine should be collected and immediately centrifuged at 2,000 revolutions per minute for 10 minutes (number of revolutions and minutes may vary depending on the centrifuge). The supernatant should be discarded and the sediment suspended in 0.3 mL of supernatant and/or saline and placed on a microscopic slide. At least 10 to 20 microscopic fields should be examined under 400x magnification.

According to the AUA, the presence of three or more red blood cells in a single, properly collected, noncontaminated urinalysis without evidence of infection is considered clinically significant microscopic hematuria.

What Blood In Your Urine Can Mean

If the specimen shows a large number of squamous epithelial cells (more than five per high-power field) or if the patient is unable to provide an uncontaminated specimen secondary to physical constraints (eg, obesity, phimosis), obtaining catheterization should be used. Sample.

The use of a simple urine dipstick test for identifying microscopic hematuria has a sensitivity greater than 90%; However, there is a substantial false-positive rate (up to 35%),

All positive results require follow-up microscopic analysis. Referral to a subspecialist should not be made unless hematuria is confirmed.

A false-positive urine dipstick test can occur in the presence of hemoglobinuria, myoglobinuria, semen, highly alkaline urine (pH greater than 9), and concentrated urine.

Haematuria In Children

Ascorbic acid (vitamin C) has been shown to cause false-negative results in dipstick tests because of its reducing properties. Therefore, patients taking vitamin C supplements and undergoing urinalysis may benefit from further microscopic examination.

Patients who test positive for hematuria with a urine dipstick test but have a negative follow-up microscopic examination should have three additional microscopic examinations to rule out hematuria. If the result of any one of these repeated tests is positive on microscopic analysis, the patient is considered to have microscopic hematuria. If all three specimens are negative on microscopy, the patient does not require further evaluation for hematuria;

If there is microscopic hematuria in the presence of pyuria or bacteriuria, a urine culture should be obtained to rule out urinary tract infection. Culture-directed antibiotics should be administered, and a microscopic urinalysis should be repeated in six weeks to assess for resolution of the hematuria.

If the hematuria resolves after the infection clears, no further exercise is necessary. If hematuria persists, a diagnostic evaluation should be initiated.

Under The Microscope: Blood

Microscopic hematuria and dysmorphic red blood cells, cellular casts, proteinuria, elevated creatinine levels, or hypertension should raise suspicion for medical renal etiologies, such as immunoglobulin A nephropathy, Alport syndrome, benign familial hematuria, or others. If any of these are suspected, a concurrent nephrologic workup is warranted.

However, these findings do not exclude the possibility of urologic processes, and evaluation for such causes should be conducted.

Many causes of microscopic hematuria do not require a thorough diagnostic workup, including strenuous exercise, infection or viral illness, menstruation, exposure to trauma, or recent urologic procedures (eg, catheterization). If a potentially benign cause is identified, the insult should be removed or treated appropriately, and the urine should be reexamined at least 48 hours later. Persistent hematuria warrants a complete workup.

All patients with confirmed asymptomatic microscopic hematuria should provide a medical history and undergo a physical examination that includes blood pressure measurement and laboratory evaluation.

Causes Of Blood In Urine (hematuria) For Females

Asymptomatic microscopic hematuria in patients receiving anticoagulants requires urologic and nephrologic evaluation regardless of the type or level of anticoagulant therapy.

A pelvic examination should be performed in women to identify a source of urethral mass, diverticula, atrophic vaginitis, or uterine bleeding. Rectal examination in men is essential to assess the size and presence of nodularity in the prostate. A serum creatinine level should be obtained to screen for medical kidney disease and to assess renal function before performing contrast-enhanced radiology tests.

Upper urinary tract imaging may be performed prior to consultation with a urologist if microscopic hematuria without known cause is confirmed.

Historically, the preferred choice for upper tract imaging was intravenous pyelography. However, this study has largely been replaced by multiphasic computed tomography (CT) urography, which combines a non-contrast phase to diagnose hydronephrosis and urinary calculi (Figure 2).

Hematuria: Causes Of Blood In Urine + 4 Natural Approaches

). CT urography is the imaging procedure of choice in the evaluation of microscopic hematuria because of its high sensitivity (91% to 100%) and specificity (94% to 97%), and its ability to provide excellent diagnostic information in a single imaging session.

A major concern with the use of CT urography is radiation exposure. The average effective dose of radiation with CT urography (7.7 mSv) is more than twice that of intravenous pyelography (3 mSv).

In an effort to reduce radiation exposure, new low-dose protocols and synchronous acquisition of nephrogenic and excretory phase images have been employed.

Use of CT urography is contraindicated in radiation-sensitive populations (eg, pregnant women) and individuals with renal insufficiency or contrast media allergy. In these patients, alternative imaging options include renal ultrasonography, magnetic resonance imaging

Blood In Urine: 9 Causes In Males

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