It is the condition in which the patient discharges urine containing blood. Hematuria may be macroscopic, when urine is markedly red or microscopic, when the presence of blood is revealed only microscopically i.e. When in a general microscopic examination of urine more than 3 red blood cells (erythrocytes) per visual field can be found.


It should be noted that the red color of urine is not always due to the presence of blood. The urine may be red colored after taking various drugs (rifampicin, phenolphthalein, phenothiazine, etc.), or due to the intake of various foods (beets, blackberries), or food coloring (rhodamine B), or even due to other medical conditions such as hemoglobinuria, myoglobinuria, etc. In such cases, urinalysis examination reveals a normal number of red blood cells.

Features of hematuria
Of particular importance for the diagnosis of the cause of hematuria is the identification of its character, that if it is: macroscopic or microscopic, at the beginning, the end or throughout the duration of urination, accompanied by gels and pain or not.

Initial hematuria usually indicates that the origin of the blood is from the urethra, terminal hematuria indicates that blood comes from the bladder and prostate “neck-triangle” and total hematuria indicates that the bleeding stems from the bladder, prostate or the upper urinary tract (kidney-ureter). The presence of pain during hematuria is usually indicative (but not conclusive) of having inflammation or calculi, while painless hematuria is usually associated with a tumor of the urinary system. Gels give information about the severity of hematuria and their shape (eg. Resembling pasta) may help in identifying its cause. It is therefore important if the patient knows and is able to describe to the physician the characteristics of the condition.

Causes of hematuria
Hematuria may be a manifestation of many urological diseases such as infections, bladder stones, benign prostatic hyperplasia and malignant neoplasms of the urinary tract (kidney, bladder, ureter, and prostate cancer). Hematuria can occur in the absence of urological disease.

For example, blood coagulation disorders, taking anticoagulants or various hematological conditions can contribute to the presence blood in urine. Moreover, otherwise healthy individuals undergoing heavy physical fatigue have often transient symptoms of proteinuria and hematuria.

Hematuria Control
In all cases, it is necessary to make a detailed diagnostic study, which (apart from the medical history and physical examination) should include laboratory tests (general and urine culture, cytologic urine examination) and imaging (ultrasound, simple x-rays or intravenous urography) as well as cystoscopy to exclude malignant disease of the urinary system whereas a CT scan is recommended in case of specific indications.

What do I need to know in a few words
Generally, macroscopic hematuria exhibits strong symptoms that immediately motivate the patient to seek medical assistance prompting the doctor to proceed in its immediate diagnosis. In most cases careful scrutiny of the urinary system eventually reveals the underlying cause. Instead, in microscopic hematuria, an underlying pathology is very often not recognized. Hematuria of any degree is a serious condition and when present in adults, it should be considered a manifestation of malignant disease of the urinary system until proven otherwise.