Investigation and Treatment of Hematuria.

Hematuria is divided into microscopic (not visible) and macroscopic (visible). In microscopic hematuria, the red blood cells are only visible under a microscope, while in macroscopic hematuria the red blood cells are numerous and color the urine. In 50% of patients with macroscoping hematuria, the underlying cause is found, while this percentage drops to 10% when it comes to microscopic hematuria. The most common causes of hematuria are:

1. urinary tract infection
2. cancer (bladder, prostate, kidney)
3. urinary tract lithiasis
4. nephritis
5. urinary tract injuries
6. blood diseases (e.g. sickle cell anemia, clotting disorders)
7. anticoagulant-antiplatelet drugs

The most common cause of hematuria is urinary tract infection, while one in five adults with gross hematuria is diagnosed with bladder cancer.

Some medicines and some foods (eg beets) can color the urine and give the false impression of hematuria.

Urinalysis-confirmed hematuria (microscopic or gross) should be investigated by taking a medical history, clinical examination, general blood and urine tests, imaging, and other specific tests. Taking the history includes questions about smoking, occupation, taking medications (eg anticoagulants), and the presence or absence of other symptoms from the urinary system (eg pain). Blood tests include complete blood count (hematocrit), blood urea and creatinine, clotting factors and prostate-specific antigen (PSA). Accept of the examination of urine, a general laboratory examination and culture of the urine can be used to determine the presence of a urinary tract infection. In addition, could be checked the presence of cancer cells under a microscope (urine cytological examination)