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Different Types of Hematuria

Hematuria is a medical condition that causes red blood cells to enter the urine. When this happens, it could be an indication that something is wrong with your body. It’s not always a serious condition, but it’s worth looking into because red blood cells aren’t supposed to mix with your urine.


While this condition isn’t normal, it’s quite common. According to JAMA Network, 2% to 30% of adults have been diagnosed with hematuria. This disease is more prominent in the elderly and smokers.

2 Types of Hematuria

Hematuria is an indication that there’s something wrong with the urinary tract. The urinary tract is composed of the kidneys, bladder, and ureter. These three work together to ensure that wastes are removed from the body. If any of these three have problems, it could result in hematuria. There are 2 types of hematuria.

 

Microscopic Hematuri

In this type of hematuria, you can’t visibly see traces of blood in the urine. You need a microscope to see it.

This is why most of these cases aren’t detected. Only a typical urine test can detect it.
When you have microscopic hematuria, there’s often no identifiable cause. This is typically referred to as idiopathic hematuria. Medical experts believe that this happens because there’s an increase in the excretion of red blood cells. This is considered to be quite normal – as long as it’s not associated with an existing condition.

 

Macroscopic Hematuria

This is also referred to as gross hematuria. In this case, the discoloration in the urine is visible to the naked eye. This happens because there’s a greater concentration of blood mixed in the urine. The urine ends up looking either pink, red, or even dark brown. Sometimes, you can even see blood clots.

A word of caution – don’t rely on the color that you see to judge the severity of your condition. Even a small quantity of blood could indicate a more serious condition.
On the other hand, just because there’s a discoloration, don’t immediately assume the worst. It only takes 1 mL of blood to change the color of your urine.

It’s always best to consult a medical professional to get the real diagnosis as to why you have hematuria. For instance, you could have what they call “joggers hematuria.” This is common among joggers and long-distance runners. All the running causes recurrent damage to the bladder, causing blood to mix into the urine.

How is Hematuria Detected?

For those with macroscopic hematuria, you should take a test upon seeing discoloration in your urine.

But for microscopic hematuria, you’ll only detect it if you take a urine test, which is one of the most common routine lab tests done by health care providers. It’s either part of your annual check-up or for something else you’re trying to diagnose. This test checks the urine sample for sugar, bacteria, and blood content.

The lab technician can either use the microscope or a chemical strip to detect the presence of blood.

What Are the Possible Causes of Hematuria?

There are many reasons why you could have hematuria.

There are benign causes that are not serious conditions. These include menstruation, kidney stones, trauma, infection, vigorous exercise, and even sexual activity.

However, it could also be caused by something more serious like kidney or bladder cancer, polycystic kidney disease, sickle cell disease, or inflammation in your bladder, urethra, kidneys, or prostate (older men).

Hematuria Diagnosis

When you’re diagnosed with hematuria, your physician will want to make sure there’s no underlying condition. Although there are non-serious causes, it could still be related to a life-threatening condition.

Health care providers will require you to take further tests if you have symptoms of a more serious condition, like cancer, that’ll have to be treated separately.

You’ll be asked a series of questions to determine the kind of lifestyle that you’re leading.
If it’s determined that it’s not cancer, the doctor would want to find out if it’s an infection that’s causing the hematuria, which could be an indication of damage in your kidneys, bladder, etc.

Further Testing for Hematuria

When you’re diagnosed with hematuria, the main concern is to ensure that it’s nothing serious. This is why further testing is often required.

There are two goals when you’re required to do this. First is to learn if there’s an abnormality in your bladder. Doctors use a cystoscope with a fiber-optic camera to visually check the bladder.

The second goal is to check your upper urinary tract, including the kidneys, ureters, etc. using an ultrasound or CT scan.

To determine what type of testing will be done, the doctor will look at your lifestyle to consider your risk of having cancer.

For low-risk individuals, the health care provider will discuss the pros and cons of doing the test. If you’re low-risk, you have the option to do another urine test after 6 months. If there are no more traces of blood, then there’s no problem. If there is, then a cystoscopy or renal ultrasound will be required.

For intermediate-risk individuals, a cystoscopy procedure and a renal ultrasound are usually recommended.

For high-risk individuals, cystoscopy and a CT scan are recommended to check the bladder and the urinary tract. Compared to ultrasound, CT scans can spot smaller abnormalities that might be a cause for concern.


Resources:
https://www.news-medical.net/health/Types-of-Hematuria.aspx, https://www.kidney.org/atoz/content/hematuria-adults,
https://www.urologyhealth.org/urology-a-z/h/hematuria, https://jamanetwork.com/journals/jama/fullarticle/2565751

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