Persistent Hematuria: When to See a Urologist

Q: Persistent Hematuria: When to See a Urologist

Hello： 1) Abnormal 2) Kidney issues 3) First, see a nephrologist. <br>If there are any urological problems, you will be referred to a urologist. <br>However, since an ultrasound has been performed, there should be no kidney issues. <br>It is advisable to see a nephrologist first.

There has been persistent hematuria detected in urine tests for two consecutive years?

Dear Doctor: I have an elevated SSA index due to an autoimmune condition and have been under continuous follow-up in the rheumatology department for 2-3 years.
However, since 2018 until mid-this year, during my check-ups every 3-6 months, my urine tests have consistently shown hematuria, with results sometimes reported as Trace, or 3+, or 2+.
Each time the urine hematuria test is abnormal, the urine sediment examination shows red blood cells <20 (sometimes 6, sometimes 18).
I inquired with my rheumatologist, who stated that this is unrelated to my autoimmune disease.
I always make sure to avoid testing around my menstrual period, and I do not have any significant discomfort.
Recently, I noticed a round lump in my right abdomen, and an ultrasound at the clinic indicated it is related to my right kidney (I am quite thin, with a BMI of about 16-17).
Occasionally, I feel soreness in my right flank, but after consulting an orthopedic specialist and having an X-ray, it was noted that I have a 15-degree scoliosis, which is not a bone issue but possibly due to insufficient core muscle strength, leading to discomfort from prolonged sitting or standing.
I would like to ask: 1.
Is it normal to have hematuria for two consecutive years? 2.
What could be the possible causes of this condition? 3.
Should I specifically see a nephrologist or urologist? Thank you!

Kunhuo de ren, 30~39 year old female. Ask Date: 2020/09/30

Dr. Du Shixi reply Urology

Hello: 1) Abnormal 2) Kidney issues 3) First, see a nephrologist.
If there are any urological problems, you will be referred to a urologist.
However, since an ultrasound has been performed, there should be no kidney issues.
It is advisable to see a nephrologist first.
Wishing you good health.

Reply Date: 2020/09/30

More Info

Persistent hematuria, or the presence of blood in the urine, can be a concerning symptom that warrants further investigation. Given your history of elevated SSA levels and ongoing monitoring for autoimmune conditions, it's understandable that you're seeking clarity on the implications of your urinary findings and whether you should consult a urologist.

1. Is it normal to have persistent hematuria for two years?
While occasional hematuria can be benign, persistent hematuria over an extended period, such as two years, is not typical and should be evaluated further. The fact that your urine tests have shown varying degrees of blood (from trace to 3+) suggests that there may be an underlying issue that needs to be addressed. It's important to note that hematuria can be caused by a variety of factors, including urinary tract infections, kidney stones, trauma, or more serious conditions such as tumors or glomerular disease.

2. What could be the potential causes of your hematuria?
The causes of hematuria can be categorized into several groups:
- Glomerular causes: These include conditions that affect the kidney's filtering units, such as glomerulonephritis or IgA nephropathy.

- Urological causes: This includes issues related to the bladder, urethra, or prostate (in men). Conditions such as urinary tract infections, bladder stones, or tumors can lead to blood in the urine.

- Systemic causes: Certain systemic diseases, including autoimmune disorders, can also manifest as hematuria. However, your rheumatologist's assessment that your autoimmune condition is not related to the hematuria is an important consideration.

Given your recent discovery of a round mass in your right abdomen, further investigation is warranted. While the ultrasound indicated that it is related to your right kidney, it is crucial to determine whether this mass is benign or if it could be contributing to your hematuria.

3. Should you see a nephrologist or urologist?
Yes, it would be advisable to consult a urologist, especially considering your persistent hematuria and the recent finding of a mass in your right abdomen. A urologist specializes in conditions affecting the urinary tract and can perform further diagnostic tests, such as a CT scan or cystoscopy, to evaluate the source of the bleeding. They can also assess the mass you felt in your abdomen to determine its nature and whether it requires intervention.

In summary, persistent hematuria is not something to be taken lightly, especially when it has been ongoing for two years. The presence of a mass in your abdomen adds another layer of complexity that needs to be evaluated. Consulting a urologist will provide you with a clearer understanding of your condition and the necessary steps to take for diagnosis and treatment. It's essential to address these symptoms proactively to rule out any serious underlying issues.

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