Haematuria (Blood in Urine)

Haematuria is diagnosed in four steps: medical history, physical examination, urinalysis, and additional tests.

• Medical history

Before doing any examination, the doctor will take your medical history to determine the cause of haematuria. You are supposed to tell about your medical history, recent medication, and symptoms.

• Physical Examination

After taking your medical history, the doctor will examine you by tapping your abdomen and back to check for pain in the bladder or kidney. In men, a digital examination is performed to check for prostate problems. In women, a pelvic examination is performed to find the source of blood in the urine.

• Urinalysis

A urine sample is taken for urine examination. A dipstick test is commonly performed to check for blood in the urine. Dipstick positive means you have blood in your urine while dipstick negative means there is no visible blood in the urine. Sometimes dipstick tests can be positive despite having normal urine. This is known as, a false-positive (not positive in reality) dipstick test. In this case, microscopy is performed to look for red blood cells.
Menstruation is the possible reason for false-positive dipstick tests.
The blood from a women’s menstrual period may mix into the urine sample, making the test false positive. In this case, the dipstick test should be re-performed after a woman stops menstruation.

Important tips while taking urine samples:

• Early morning
• Mid-stream urine (after peeing a little urine)
• After menstruation
• After healing of wound at peeing place (if any)

• Further tests

If too many red blood cells are detected in the patient’s sample then the physician would recommend further tests.

• Urine culture: To determine if any pus cells and bacterial or fungal infections are present.
• Blood test: To determine the creatinine level (a waste product of the kidney).
• CT Scan (computed tomography): X-rays of the urinary tract or kidney. For X-rays, you have to lie down on a plane table that slides into an image-taking device. No anesthesia is given to the patient. A Radiologist will interpret the results including cysts, obstructions, traumatic injuries, tumors or cancers, and stones in the urinary tract or kidney.
• Cystoscopy: After a CT scan, the urologist will do a cystoscopy if recommended by the radiologist. Cystoscopy is a procedure in which a tube-like instrument is inserted into the patient’s urethra and bladder. It may be a painful procedure and the doctor will recommend a pain reliever. It is a very useful technique for detecting bladder cancer.
• Kidney Biopsy: Cutting of small pieces of tissues from the kidney. The procedure is performed by the surgeon in a hospital and mostly slight local anesthesia is given to the patient. However, in some cases, general anesthesia may require. The part of kidney tissues is then examined by the pathologist, who will examine it in a laboratory. He will tell you whether the haematuria is due to kidney disease or due to some other medical issues.
• MRI (magnetic resonance imaging): The image of internal organs without using X-rays. No need for anesthesia while slight sedation may give to patients showing fear. A technician will take the image and a patient will hear a knocking or loud noise from the MRI machine. MRI report will help the urologist see the internal kidney or bladder problems.

You should consider a proper investigation approach (as shown here).