Blood in Urine: Kidney Issues and Diagnostic Challenges

Q: Blood in Urine: Kidney Issues and Diagnostic Challenges

Hello： If the X-ray with contrast agent shows a clear image on the right side but not on the left side, it may indicate a potential issue that requires further examination. <br>The physician will arrange for additional tests, as there are many possibilities, with stones being the

Kidney and Hematuria Issues

Hello Doctor: I have hematuria, but I don't have bladder pain or urgency, and I don't have many symptoms.
However, there is some hydronephrosis on the left side.
I had an X-ray with contrast, but why is the right side clear while the left side is not well visualized? What could this condition indicate? I also have lower back soreness, but no pain elsewhere!

Liao Meimei, 60~69 year old female. Ask Date: 2017/03/16

Dr. Du Shixi reply Urology

Hello: If the X-ray with contrast agent shows a clear image on the right side but not on the left side, it may indicate a potential issue that requires further examination.
The physician will arrange for additional tests, as there are many possibilities, with stones being the most common.
The physician is particularly concerned about the presence of any abnormal growths, so further evaluation will be scheduled.
Thank you for your inquiry.

Reply Date: 2017/03/16

More Info

Hello! Thank you for your question regarding the presence of blood in your urine, kidney issues, and the diagnostic challenges you are facing. Blood in the urine, also known as hematuria, can be a concerning symptom and may indicate various underlying conditions, particularly related to the urinary tract or kidneys.

From your description, it appears that you are experiencing hematuria without accompanying symptoms such as bladder pain or urgency. Additionally, you mentioned that there is some hydronephrosis (swelling of the kidney due to urine buildup) on the left side, and you have undergone imaging studies, including X-rays with contrast, which have not provided clear results for the left kidney.

Possible Causes of Hematuria
1. Kidney Stones: One of the most common causes of hematuria is kidney stones. Even if stones are not visible on imaging, they can still cause irritation or obstruction, leading to bleeding.

2. Urinary Tract Infections (UTIs): Although you do not report symptoms typical of a UTI, infections can sometimes present with hematuria without other obvious signs.

3. Glomerular Disease: Conditions affecting the glomeruli (the filtering units of the kidneys) can lead to blood and protein in the urine. This includes diseases like IgA nephropathy or glomerulonephritis.

4. Tumors: Both benign and malignant tumors in the kidneys or bladder can cause hematuria. Imaging studies are crucial in evaluating these possibilities.

5. Trauma: Any recent trauma to the kidneys or urinary tract can also lead to bleeding.

Diagnostic Challenges
The fact that your left kidney is not clearly visible on imaging could be due to several factors, including:
- Technical Limitations: Sometimes, the positioning of the patient or the quality of the imaging can affect the visibility of certain structures.

- Anatomical Variations: Individual anatomical differences can make certain areas more challenging to visualize.

- Pathological Changes: Hydronephrosis or other pathological changes can obscure the view of the kidney.

Recommendations
1. Follow-Up Imaging: Given the hydronephrosis and the unclear imaging results, further evaluation is warranted. A CT scan with contrast may provide better visualization of the kidneys and urinary tract. This imaging can help identify any obstructions, stones, or other abnormalities.

2. Urinalysis: A comprehensive urinalysis, including microscopic examination, can help determine the cause of hematuria. This should include testing for protein, glucose, and signs of infection.

3. Referral to a Specialist: If you haven’t already, consider consulting a urologist. They can provide specialized care and may recommend additional tests, such as a cystoscopy, to directly visualize the bladder and urethra.

4. Monitoring Symptoms: Keep track of any changes in your symptoms, such as the onset of pain, changes in urination patterns, or any new symptoms. This information can be crucial for your healthcare provider.

Conclusion
In summary, while the presence of blood in your urine can be alarming, it is essential to approach the situation methodically. The combination of imaging studies, urinalysis, and specialist consultation will help clarify the underlying cause of your symptoms. Early diagnosis and treatment are key to managing any potential kidney issues effectively. Please ensure to follow up with your healthcare provider for further evaluation and management. Wishing you the best of health!

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