Hematuria

Blood in the urine is common. but it is not considered normal. Blood in the urine almost always deserves a full evaluation.

Blood may be visible to you. This is called gross hematuria (because it is grossly visible not because it is gross). It will appear red, pink or rust colored. There can be clotting or flecks of red blood. You may see blood only one time or there may he repeated episodes. Any of these indicate there may be a problem. Gross hematuria always requires evaluation with cystoscopy, kidney imaging such as CT scan, and urine testing for infection and possibly cytology or FISH testing.

The blood may only be visible under a microscope (called, for obvious reasons, microscopic hematuria). Microscopic hematuria can indicate just as serious of a problem as gross hematuria and requires a similar evaluation in most cases. Some patients have low risk microhematuria that does not require invasive testing. The algorithm from the AUA guidelines are pictured below as a reference point.

Blood that is visible and blood that is microscopic both require full evaluation to determine if there is a problem that needs to be addressed. Full evaluation typically requires a CT scan or an ultrasound of the kidneys, a cystoscopy look into the bladder, and often urine testing to look for cancer cells such as urine cytology or urinary FISH to look for cancer cells in the urine.

Common problems causing blood in the urine include infections, kidney stones, and cancers such as bladder or kidney cancer.

Blood in the urine may not reveal any problems at all. You may have blood in the urine without ever having any problem develop because of it.