Urinary Blood: What to Do When You See +2 Results

Urinary dipstick test

Hello Doctor: I would like to ask about my recent health concerns.
Three months ago, I had a urinalysis that showed a +1 reaction, which I believe was influenced by my menstrual cycle.
After my period ended, I went to the hospital and had another urinalysis that showed trace hematuria (+/-).
I then underwent an ultrasound of my bladder and kidneys, and the doctor mentioned that there were only calcifications in my kidneys that needed to be monitored.
However, I still had a hematuria reaction, which this time was +2.

A few days ago, I had another health check with a urinalysis that again showed +2 (on 2/17).
The blood tests came back normal, but the urinalysis showed +2 for hematuria.
When I brought the report to the hospital, the doctor advised me to either continue monitoring or see a gynecologist.
I consulted the gynecologist, who performed an ultrasound and found uterine fibroids, but they also recommended that I follow up with a urologist.

Should I schedule an appointment with a nephrologist? The doctor did not order an X-ray; should I request one? My last menstrual period started on 2/1, but I currently feel a sense of pressure and pain in my uterus, as if my period is about to start again.
Could this affect the urinalysis results and cause hematuria? I am quite confused and unsure about what to do.
🤔

Xinxin, 40~49 year old female. Ask Date: 2019/02/21

Dr. Xu Wencang reply Urology

Further reference to the number of red blood cells under the microscope is needed.
Continued outpatient follow-up is required, and further examinations should be conducted.

Reply Date: 2019/02/21

More Info

When you encounter a urinary blood test result showing +2, it can understandably raise concerns. The presence of blood in urine, known as hematuria, can stem from various causes, and understanding the implications of your test results is crucial for determining the next steps in your evaluation and management.

Firstly, it’s important to clarify what a +2 result means. In urinalysis, the presence of blood is indicated by a dipstick test, and a result of +2 suggests a moderate amount of blood in the urine. This can be due to a variety of reasons, including urinary tract infections (UTIs), kidney stones, trauma, or even more serious conditions like tumors in the urinary tract. Given that you have had a history of +1 and now +2 results, it is essential to investigate further.

Your recent tests, including ultrasound examinations of the kidneys and bladder, have shown only calcifications in the kidneys, which may not be significant. However, the persistent presence of blood in your urine warrants further exploration. The fact that your gynecologist has noted a uterine fibroid but has also recommended follow-up with a urologist indicates that the source of the hematuria may not be gynecological in nature.

Here are some considerations and recommendations based on your situation:
1. Follow-Up with a Urologist: Since you have been referred back to urology, it is advisable to follow this recommendation. Urologists specialize in urinary tract issues and can provide a more focused evaluation of hematuria. They may recommend additional tests, such as a cystoscopy, which allows direct visualization of the bladder and urethra, or a CT scan to assess for stones or other abnormalities in the urinary tract.

2. Requesting Additional Imaging: If you feel that your concerns are not being adequately addressed, it is reasonable to request further imaging studies, such as an X-ray or CT scan, particularly if there is a suspicion of stones or other obstructive processes. These tests can help rule out significant issues that might not be visible on ultrasound.

3. Impact of Menstrual Cycle: It is also worth noting that menstruation can sometimes lead to trace amounts of blood in the urine, particularly if there is any contamination during the sample collection. However, a consistent +2 result suggests that there may be an underlying issue that needs to be addressed, independent of your menstrual cycle.

4. Monitoring Symptoms: Pay attention to any additional symptoms you may experience, such as pain during urination, changes in urinary frequency, or any abdominal pain. These symptoms can provide valuable information to your healthcare provider regarding the potential cause of your hematuria.

5. Consideration of Other Factors: Factors such as recent physical activity, dehydration, or urinary tract infections can also influence urinalysis results. Ensure you are well-hydrated and avoid strenuous activities before testing, as these can sometimes lead to transient hematuria.

In summary, while a +2 result in your urinalysis indicates a need for further investigation, it is essential to work closely with your healthcare providers. Following up with a urologist, discussing the need for additional imaging, and monitoring your symptoms will help ensure that any underlying issues are identified and managed appropriately. If you continue to have concerns or if your symptoms worsen, do not hesitate to seek immediate medical attention. Your health and peace of mind are paramount, and proactive management is key to addressing any potential urinary tract issues.

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