What is Haematuria (Blood in Urine)?
Haematuria means the presence of blood (red blood cells) in the urine. There are two types: gross (visible) haematuria — urine appears pink, red, or cola-coloured and is easily noticed — and microscopic haematuria — blood is not visible to the naked eye but is detected under the microscope during urine routine examination (reported as "RBCs seen" or "hpf" in urine test reports). Both types require medical evaluation, though gross haematuria understandably causes more alarm.
Blood in urine should never be assumed to be harmless or self-limiting. Even a single episode of painless gross haematuria, or persistent microscopic haematuria found on a routine test, warrants proper investigation. Dr. Swaranjeet Kaur at Pragma Medical Institute, Bathinda provides systematic, thorough evaluation of all patients presenting with haematuria to identify the cause and initiate appropriate treatment.
Causes of Blood in Urine — From Common to Serious
Urological Causes (Urinary Tract)
- Kidney stones — The most common cause of painful gross haematuria. Stones scratch the urinary tract lining as they pass, causing bleeding. Often accompanied by severe flank pain.
- Urinary tract infection (UTI) — Bacterial infection of the bladder, urethra, or kidney. Usually accompanied by burning, frequency, and urgency. Very common, especially in women.
- Kidney infection (Pyelonephritis) — UTI that has ascended to infect the kidney. Accompanied by fever, rigors, flank pain.
- Bladder cancer — Painless gross haematuria in adults, especially smokers above 50 years, must be evaluated for bladder cancer. This is a serious but treatable condition when caught early.
- Kidney cancer (Renal cell carcinoma) — Can cause painless blood in urine. Increasingly common. Requires urgent evaluation with imaging.
- Prostate conditions — Enlarged prostate (BPH) or prostate cancer in older men.
- Trauma — Injury to the kidney or urinary tract from accidents.
Kidney (Nephrological) Causes
- IgA nephropathy (Berger's disease) — Most common kidney disease causing gross haematuria, often triggered by throat infections or exercise. Urine turns red 1-3 days after an upper respiratory infection. A common condition in young adults in Punjab.
- Thin basement membrane disease — Genetic thinning of the glomerular filter causing painless microscopic haematuria. Usually benign with good long-term prognosis.
- Alport syndrome — Genetic disorder of the glomerular basement membrane; progressive kidney disease with hearing loss and eye changes.
- Glomerulonephritis — Various immune-mediated kidney diseases causing inflammation and haematuria.
- Lupus nephritis — Autoimmune kidney disease in lupus patients.
- Polycystic kidney disease — Cyst bleeding causing gross haematuria.
How to Tell if Blood in Urine is from Kidneys vs Bladder
| Feature | Kidney Origin | Bladder/Urethra Origin |
|---|---|---|
| Pain | Flank/back pain (if kidney involved) | Burning, lower abdominal pain |
| Blood in urine | Throughout urination stream | Beginning or end of stream |
| Protein in urine | Often present (nephrology cause) | Usually absent |
| Red cell casts (microscopy) | Pathognomonic of kidney origin | Absent |
| Fever | If kidney infection | If bladder infection |
| Associated proteinuria | Common | Uncommon |
Do NOT Ignore Blood in Urine If:
Painless blood in urine in adults above 40 years (could be bladder or kidney cancer — requires urgent urology and nephrology evaluation); blood in urine with protein in urine report (indicates kidney disease); blood in urine recurring repeatedly; blood in urine in a child (requires pediatric nephrology evaluation); or blood in urine after taking herbal medicines (possible drug toxicity).
Diagnosis of Haematuria — What Tests Does Dr. Swaranjeet Kaur Order?
- Urine routine & microscopy — Quantifies RBCs, detects red cell casts (pathognomonic of glomerular disease), protein, WBCs
- Urine culture and sensitivity — To rule out or confirm UTI
- Spot urine protein-creatinine ratio — Quantifies protein leakage
- Serum creatinine and eGFR — Kidney function assessment
- CBC — Blood count to assess anaemia from bleeding
- Coagulation tests (INR/PT) — To rule out bleeding disorder
- Kidney ultrasound — First-line imaging for kidney structure, stones, cysts, tumors
- CT urogram (non-contrast + contrast) — Gold standard for detecting stones, tumors, structural abnormalities throughout the urinary tract
- Cystoscopy — Direct visualization of the bladder (done by urologist) — essential for haematuria evaluation in adults above 40
- Kidney biopsy — If nephrology cause suspected and biopsy would change management
- Specific blood tests — ANA, ANCA, C3/C4 (for glomerulonephritis), IgA levels, anti-GBM antibody
Treatment of Haematuria — Based on Cause
- UTI: Appropriate antibiotics based on urine culture sensitivity
- Kidney stones: Hydration, pain relief, stone-specific treatment (medical or surgical as needed)
- IgA nephropathy: ACE inhibitors/ARBs, omega-3 fatty acids, immunosuppressants in selected cases with significant proteinuria or declining kidney function
- Glomerulonephritis: Steroids and immunosuppressants based on kidney biopsy results
- Bladder/kidney cancer: Urgent urological referral for staging and treatment planning
- Thin basement membrane disease: Often monitoring only; ACE inhibitors if significant proteinuria develops
Found Blood in Your Urine? Get Expert Evaluation Today
Blood in urine should never be dismissed or left uninvestigated. Dr. Swaranjeet Kaur at Pragma Medical Institute, Bathinda provides systematic, thorough evaluation to identify the cause and begin the right treatment promptly.
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