What Causes Red Blood Cells In Urine – Hematuria refers to the presence of blood in the urine. It is defined by the identification of three or more red blood cells (erythrocytes) per high-powered field (HPF) in a urine sample. RBCs in urine can originate from the kidneys or anywhere else in the urinary tract, which consists of the ureters, bladder, prostate (in males at birth), and urethra.

The term hematuria comes from the Greek words “hema-” which refers to blood and “-uria” which refers to urine. Blood in the urine may be visible to the naked eye (ie, gross hematuria) or it may be detected microscopically (ie, microscopic hematuria). Asymptomatic or symptomatic hematuria can be associated with many different medical conditions and should be investigated when discovered.

What Causes Red Blood Cells In Urine

Hematuria usually occurs as a result of pathologies of the urogenital system, but systemic diseases can also be manifested by blood in the urine.

The Causes Of Blood In Your Urine

Most often, the observation of blood in the urine indicates an infection of the bladder (i.e. Cystitis) or kidney (i.e. Pyelonephritis). Hematuria can also be caused by injuries to the urinary tract, from kidney stones to accidents such as improper insertion of a Foley catheter or a fall that injures the kidney. Hematuria is also often associated with nephritic syndrome, which can be the result of glomerulonephritis, an inflammatory condition that damages the blood-filtering part of the kidney (ie, the glomeruli). In addition, polycystic kidney disease, an inherited disease in which cysts develop on the kidneys, can also cause hematuria. Malignancies such as renal cell carcinoma, bladder cancer, and prostate cancer can also cause hematuria.

Certain systemic conditions can also cause hematuria, including Alport syndrome, a condition that affects the small vessels of the kidneys; Goodpasture syndrome, an autoimmune disorder that affects the lungs and kidneys; and lupus nephritis, which is characterized by inflammation of the kidneys triggered by lupus. These conditions can lead to nephritic syndrome, which manifests as hematuria. Individuals with a bleeding diathesis, such as those using blood thinners or thrombocytopenic individuals, may also experience blood in the urine. Individuals with sickle cell anemia, a genetic disease in which red blood cells are abnormally shaped, also often experience hematuria.

When the presence of blood in the urine is unrelated to the urinary system, it can be associated with a variety of conditions, including an enlarged prostate (ie, benign prostatic hyperplasia); endometriosis (ie, ectopic endometrial tissue) in the ureter, urethra, kidneys, or bladder; vigorous exercise; menstruation; or even recent sexual activity. Finally, certain foods (eg, beets) and medications (eg, rifampin) can change the color of an individual’s urine, which can be mistaken for hematuria.

To diagnose hematuria, a health care provider will usually begin by evaluating an individual’s symptoms, past medical history, and current medications. Individuals with gross hematuria may have pink, red, or brown urine. In most cases, people with gross hematuria are asymptomatic or may present with mild symptoms such as pain during urination or urgency. Hematuria, which is manifested by blood clots in the urine, can sometimes be accompanied by bladder pain or back pain. A physical examination should always be performed to assess for tenderness and pain in the lower abdomen, pelvis, and hips (ie, vertebral angle tenderness).

Leukocytes In Urine: What Does Leukocyte Esterase In Urine Mean?

Additional tests are usually needed to determine the cause of the hematuria. A urinalysis is the initial and most useful test. The presence of three or more erythrocytes per HPF in urinalysis is characteristic of microscopic hematuria. Another option is to do a urine dipstick, but it is not as diagnostic and has many false positive or false negative results. Urine appearance, pH, presence of protein, white blood cells (WBC), nitrites, crystals, and casts can also aid in the diagnostic process. For example, a urine sample with significant white blood cells and positive nitrites indicates a urinary tract infection (UTI) due to gram-negative organisms as the likely cause of hematuria. Similarly, the identification of excessive protein with hematuria favors the diagnosis of glomerulonephritis. Additional urine microscopy can be performed to examine urine sediments for erythrocyte morphology and erythrocyte casts. Microscopy is the most important examination that can distinguish between glomerular and non-glomerular hemorrhages. Dysmorphic erythrocytes and erythrocyte casts, when identified, are diagnostic of glomerular pathology.

Initial ultrasound imaging of the kidneys, ureters, and bladder may also be performed in individuals with hematuria to help diagnose anatomic causes of hematuria, such as a kidney stone or other mass. It can also be used to detect kidney cysts. Abdominopelvic CT with or without contrast is the preferred method for detecting kidney stones and other morphological abnormalities of the kidney. Abdominal and pelvic MRI are other useful modalities when CT is contraindicated or unhelpful.

Cystoscopy can also be used to detect carcinomas and inflammations. It can also be used for therapeutic purposes by removing stones that remain in the bladder. Finally, a renal biopsy is usually required to diagnose a glomerular cause of hematuria.

Treatment for hematuria depends on the underlying cause. In asymptomatic individuals with rare cases of hematuria, negative imaging, stable renal function, and absence of proteinuria, observation may be a sufficient therapeutic approach.

Red Blood Cell

Symptomatic cases and those with clear underlying causes will require specific treatment to address the underlying condition. These treatments may include antibiotics, immunosuppressive therapies, symptom management, and in some cases, surgery.

Hematuria refers to the presence of blood in the urine and can be classified as either microscopic or macroscopic. Hematuria usually occurs as a result of pathologies of the urogenital system, such as UTIs, stones, trauma and malignancies. However, systemic conditions such as Alport’s and Goodpasture’s syndromes can also present with blood in the urine. Diagnosis is based on history and clinical presentation, but further tests such as urinalysis, urine microscopy, bladder and kidney ultrasound, CT and kidney biopsy can be performed to confirm the diagnosis. Treatment depends on the underlying cause.

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O’Leary, M. P., Glassock, R. J., & Lam, A. Q. (2020, December 9). Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics). In UpToDate. Retrieved November 5, 2021, from https://www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics.

What Blood In Your Urine Can Mean

Saleem, M. O, & Hamawy, K. (2021, August 11). hematuria. In StatPearls [Internet]. Retrieved November 1, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK534213/

US Department of Health and Human Services. (2016, July). Hematuria (blood in the urine). At the National Institute for Diabetes and Digestive and Kidney Diseases. Retrieved November 1, 2021, from https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine. Gross hematuria occurs when the urine is red, brown, or tea-colored due to the presence of blood. Hematuria can also be subtle and can only be detected with a microscope or a laboratory test.

The blood that collects and mixes with the urine can come from anywhere in the urinary system, including the kidneys, ureter, bladder, urethra, and prostate.

Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise.

Blood In The Urine And Other Symptoms Of A Uti

These causes are classified into glomerular and non-glomerular causes depending on the involvement of the renal glomerulus.

Other substances, such as certain medications and foods (eg, blackberries, beetroot, food dyes) can cause urine to appear red.

Menstruation in women can also cause hematuria and can result in a positive urine dipstick test for hematuria.

A urine dipstick test can also give a false positive for hematuria if there are other substances in the urine, such as myoglobin, a protein that is excreted in the urine during rhabdomyolysis. A positive urine dipstick test should be confirmed by microscopy, where hematuria is determined by three or more red blood cells per high-power field.

Urine Analysis: Part 2

Once hematuria is detected, a thorough history and physical examination with appropriate follow-up evaluation (eg, laboratory testing) can help determine the underlying cause.

Many causes can present as gross hematuria or microscopic hematuria, so the differential diagnosis is often organized around glomerular and nonglomerular causes.

While the urine dipstick test can identify heme in red blood cells, it also identifies free hemoglobin and myoglobin.

Free hemoglobin can be found in the urine due to hemolysis and myoglobin can be found in the urine due to rhabdomyolysis.

Blood In Urine

Thus, a positive dipstick test does not necessarily indicate hematuria; instead, urine microscopy showing three or more red blood cells per high-power field confirms hematuria.

In women, menstruation can cause hematuria and can result in a positive urine dipstick test for hematuria.

Menstruation can be ruled out as a cause of hematuria by inquiring about the menstrual history and ensuring that the urine sample is collected without menstrual blood.

The evaluation of hematuria depends on the visibility of blood in the urine (ie, visible/gross vs. microscopic hematuria).

Rbc In Urine: What It Means, Ranges, And Test Results

Hematuria alone without accompanying symptoms is cause for suspicion of malignancy of the urinary tract until proven otherwise.

Initial evaluation of patients with signs and symptoms consisting of hematuria includes assessment of hemodynamic status, underlying cause of hematuria, and provision of urine drainage. These steps include an assessment of the patient’s heart rate, blood pressure, a medical examination by a healthcare professional,

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