Blood in Urine: When to Seek Further Testing

Q: Blood in Urine: When to Seek Further Testing

Hello： Follow up in six months and also monitor the color of your urine. <br>If it appears reddish, seek medical attention immediately as it may require examination of the bladder and a re-evaluation of the kidneys. <br>If there is hematuria, it should be investigated as there ma

The presence of red blood cells in urine?

Hello Dr.
Du: Recently, I underwent a health check-up, and my urine test showed 2-5 red blood cells, with a hematuria reaction marked as +-.
The urine protein test was normal, and the abdominal ultrasound was also normal.
There was only a note to continue monitoring, and no referral was made.
In my daily work, I often experience urinary retention and drink very little plain water, mostly coffee, milk, and tea.
Recently, I have changed my habits and started drinking a lot of plain water, resulting in increased urination and no more urinary retention.
Could you please advise how long I should wait before having another check-up? What kind of tests should I undergo first? Thank you.

KC, 50~59 year old female. Ask Date: 2019/01/13

Dr. Du Shixi reply Urology

Hello: Follow up in six months and also monitor the color of your urine.
If it appears reddish, seek medical attention immediately as it may require examination of the bladder and a re-evaluation of the kidneys.
If there is hematuria, it should be investigated as there may be an underlying issue, although most cases do not reveal any significant findings.
Additionally, limit your intake of beverages, and if you have high blood pressure or blood sugar, make sure to manage them properly.
Wishing you good health.

Reply Date: 2019/01/13

More Info

When it comes to the presence of blood in urine, also known as hematuria, it is essential to understand the underlying causes and when to seek further testing. Hematuria can be classified into two types: gross hematuria, where blood is visible to the naked eye, and microscopic hematuria, where blood is only detectable under a microscope. In your case, the presence of 2-5 red blood cells per high power field (RBCs/HPF) and a trace of blood (indicated by the +- reaction) suggests microscopic hematuria.

The first step in addressing your concerns is to consider the potential causes of hematuria. These can range from benign conditions, such as dehydration or urinary tract infections (UTIs), to more serious issues like kidney stones, glomerulonephritis, or even tumors in the urinary tract. Given that your urine protein levels are normal and your abdominal ultrasound was clear, this is a positive sign, but it does not completely rule out the need for further investigation.

Your recent lifestyle changes, such as increasing your water intake and reducing the consumption of caffeinated beverages, may also play a role in your urinary health. Dehydration can concentrate urine and potentially lead to irritation of the urinary tract, which might cause blood to appear. It is good to hear that you are now drinking more water and urinating more frequently, as this can help dilute the urine and reduce irritation.

In terms of follow-up, it is generally advisable to monitor your symptoms closely. If the hematuria persists or if you experience additional symptoms such as pain during urination, frequent urination, or any abdominal pain, you should seek further evaluation sooner rather than later. A repeat urinalysis can be performed in a few weeks to see if the hematuria resolves with your increased fluid intake. If the hematuria continues, further testing may be warranted, including a urine culture to rule out infections, a CT scan to check for stones or other abnormalities, or a referral to a urologist for a more comprehensive evaluation.

In summary, while your current findings may not indicate an immediate cause for alarm, it is essential to remain vigilant. Continue to monitor your symptoms and maintain your increased fluid intake. If the hematuria persists or worsens, do not hesitate to seek further medical advice. Regular follow-ups with your healthcare provider will ensure that any potential issues are addressed promptly.

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