Some causes of haematuria are , temporary states that do no lasting harm and resolve with little or no specific treatment. Some causes, however, may be due to more serious conditions. To determine the cause of haematuria, and decide what treatment (if any) is required, your doctor will make an assessment based on your symptoms, medical history, physical examination and the results of any investigations undertaken.
This may include asking questions, such as:
Is it really blood?
A number of other things can cause urine to change colour e.g.
- Reddish-brown colouring can also come from eating foods such as beetroot and rhubarb or taking medication such as rifampicin.
- Haemoglobinuria is the presence of haemoglobin in the urine. Some conditions (e.g. sickle cell anaemia) cause red blood cells to break apart (haemolyse) and release haemoglobin, the iron-containing protein that gives red blood cells their colour. The excess haemoglobin is eliminated through the urine, causing it to turn red or tea-coloured.
- Bilirubin is a breakdown product of haemoglobin normally removed by the liver, but it can accumulate when the liver is damaged or diseased, and can cause urine to be a dark amber colour.
Is the blood from the urinary tract?
Contaminating blood may find its way into the urine from:
- Vaginal bleeding in women, such as from menstruation (periods)
Is it due to an infection?
Infections can sometimes cause cloudy, smelly urine, with painful urination, and occasionally haematuria.
Is the blood from a single isolated incident or from a known cause?
Sometimes blood may appear and then go away without the cause ever being identified. In other cases, it may be from an identifiable, resolvable or self-limited cause, such as:
- Strenuous exercise
- Exposure to toxins, such as contrast dyes used in radiologic procedures (X rays or CT scans)
- Medications such as , aspirin, or that inhibit clotting and may increase the risk of a person having bleeding episodes with blood in the urine
- A medical procedure that physically involves part of the urinary tract, such as surgery, a kidney , or inserting a urinary , can cause temporary bloody urine.
- Physical injury to the kidney or bladder, such as trauma
- An isolated incident (cause never identified)
Is the haematuria due to an inflammation or irritation of the urinary tract (or prostate in men) or due to blockage by, or the passage of, a kidney stone?
The following can cause blood in the urine and sometimes radiating pain, painful urination, urinary urgency (sudden urge to pee), and/or urinary hesitancy (difficulty in getting started):
Is it caused by kidney disease or a condition that can cause kidney damage?
- There are a variety of kidney diseases that can cause haematuria. An example is glomerulonephritis, a kidney disease associated with the filtering units in the kidneys (glomeruli).
- Diabetes and high blood pressure (hypertension) are common causes of kidney damage and can sometimes result in haematuria.
- Polycystic kidney disease is an inherited disorder that can lead to the formation of in the kidneys and can lead to kidney disease.
Is haematuria due to some other disease or condition within the urinary tract?
- Structural abnormalities within the urinary tract can cause bleeding.
- Blood clots can form within the urinary tract.
Is the haematuria due to some other underlying chronic and/or inherited disorder?
This may be a disorder that affects the body as a whole (systemic) or that results in excess blood within the urinary tract, leading to haematuria. Some examples include:
- Bleeding disorders—these can lead to excessive bleeding episodes (bloody noses, bruising, prolonged bleeding, etc.) throughout the body. Examples include haemophilia and thrombocytopaenia.
- Alport syndrome—an inherited condition associated with haematuria and protein in the urine
- Autoimmune disorders—with this group of diseases, the body's immune system mistakenly attacks and damages its own tissue and organs, including the kidneys.
Is haematuria due to cancer?
Cancers associated with the urinary tract and prostate can cause haematuria. These include: