Blood in Urine: Possible Causes and Concerns

Other tests are normal, yet there is hematuria?

Hello Doctor, I was hospitalized for acute pyelonephritis a little over a month ago.
During my follow-up appointment in mid-March, both my urinalysis and ultrasound results were normal.
Recently, I've been feeling unwell, experiencing vomiting, some swelling and mild pain in my lower back, and a slight fever.
I'm worried about a recurrence, so I went back to the hospital for an examination.
The ultrasound and kidney function tests were normal, and there were no signs of infection, but there was mild hematuria in my urine.
Shortly after returning home, my menstrual period started.
Could the timing of my menstrual cycle (or just a few hours before) affect the urinalysis results? I've also been frequently experiencing pain in my right upper abdomen; could this be due to kidney stones?

Emily, 30~39 year old female. Ask Date: 2016/04/06

Dr. Li Xinyi reply Urology

Ultrasound and X-ray imaging can detect kidney stones, but the visibility of the stones may vary depending on their size, location, and composition.
It is possible that the results of a urinalysis could be affected by hormonal changes occurring just before menstruation or a few hours prior.

Reply Date: 2016/04/06

More Info

Blood in urine, or hematuria, can be a concerning symptom that warrants thorough investigation, especially in the context of previous kidney issues such as acute pyelonephritis. In your case, it seems that you have a history of kidney problems, and the recent symptoms you describe—vomiting, mild fever, and abdominal pain—could indeed indicate a potential recurrence or another underlying issue.

To address your specific questions:
1. Impact of Menstruation on Urinalysis: Yes, menstruation can affect the results of a urinalysis. If you are menstruating, it is possible for menstrual blood to contaminate the urine sample, leading to the appearance of blood in the urine. This is particularly relevant if the urine sample was collected during your menstrual period. It is advisable to inform your healthcare provider about your menstrual cycle when discussing urinalysis results, as this context can help interpret the findings more accurately.

2. Possible Causes of Right Upper Abdominal Pain: The right upper abdominal pain you are experiencing could potentially be related to kidney stones, especially if you have a history of kidney issues. Kidney stones can cause pain that radiates to the back and can be associated with hematuria. However, other conditions, such as gallbladder disease or liver issues, could also cause similar symptoms. Given your history of acute pyelonephritis, it is essential to monitor for any signs of recurrent infection or complications related to kidney stones.

3. Next Steps: Since your ultrasound and kidney function tests are normal, it may be beneficial to consider further imaging studies, such as a CT scan, to evaluate for kidney stones or other abnormalities that may not be visible on ultrasound. Additionally, if your symptoms persist or worsen, or if you develop new symptoms such as fever or significant pain, you should seek medical attention promptly.

4. Monitoring and Follow-Up: It is crucial to maintain regular follow-up appointments with your healthcare provider, especially given your history of kidney issues. They can help monitor your kidney function and address any new symptoms that arise. If you continue to experience hematuria, further evaluation may be warranted to rule out other potential causes, such as urinary tract infections, tumors, or other renal pathologies.

In summary, while menstruation can influence urinalysis results, your symptoms warrant careful monitoring and possibly further investigation to rule out any serious underlying conditions. If you have concerns about kidney stones or recurrent infections, discussing these with your healthcare provider is essential for appropriate management and peace of mind.

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