Hematuria: Causes, Diagnosis, and Management

Urinary occult blood issue?

Hello Doctor: Since the health check in December last year, I have had urine occult blood 1+.
In January, due to gastrointestinal issues, I went to the emergency room and the urine test again showed occult blood 1+.
At that time, I underwent a contrast-enhanced abdominal CT scan.
In February, I was diagnosed with acute cystitis and had urine occult blood 2+.
After that follow-up visit, there was no occult blood, but subsequent visits showed urine occult blood 1+ with a slight increase in red blood cell count.
In March, the doctor performed an X-ray, bladder ultrasound, and kidney ultrasound, which did not reveal any stones.
There was a 0.1 cm lipoma in the left kidney.
In April, I consulted a urologist due to frequent urination and lower abdominal pain.
The urine test showed a +/- result for occult blood, and the doctor indicated the presence of white blood cells, suggesting an infection.
The diagnosis at that time for the frequent urination and lower abdominal pain was pelvic fascia inflammation, and I underwent urodynamics.
In May, during a follow-up with the urologist, I was on my menstrual period and had urine occult blood 2+ with red blood cells.
The doctor arranged for an intravenous pyelogram (IVP) and urine cytology, both of which returned normal results, and I was advised to return in August.
In June, due to a weight loss of nearly 4 kg since March, I visited a family medicine doctor.
The urine test still showed urine occult blood 1+ with a significant increase in red blood cells (RBC/hpf 26.2, RBC/μL 144).
I am unsure if this is related to exercising in the morning and only drinking a little water on an empty stomach.
At that time, my fasting blood glucose was 96, hemoglobin A1c was 5.7, and thyroid function was normal.
I would like to ask the doctor: 1.
Do I need to undergo any further tests? The urologist mentioned that sometimes the cause of urine occult blood cannot be identified and advised me not to be overly anxious.
2.
I occasionally experience left lower back pain.
Given that I am quite thin (BMI around 15), could this be related to a floating kidney or nutcracker syndrome? 3.
My weight loss should not be related to the urine occult blood, right? Thank you, Doctor.

Niming, 30~39 year old female. Ask Date: 2021/06/05

Dr. Du Shixi reply Urology

Hello, 1) All possible tests have been conducted.
2) Imaging studies will typically reveal findings, at least raising suspicion; if there are no abnormalities in the imaging studies, the likelihood is extremely low.
3) The likelihood is extremely low; wishing you good health.

Reply Date: 2021/06/05

More Info

Hematuria, or the presence of blood in urine, can be a concerning symptom that warrants thorough investigation. Your case presents a complex history of intermittent hematuria, urinary tract infections, and weight loss, which raises several important questions regarding potential underlying causes and the need for further diagnostic evaluation.

Firstly, it is essential to understand that hematuria can arise from various sources within the urinary tract, including the kidneys, ureters, bladder, and urethra. The causes can range from benign conditions, such as urinary tract infections (UTIs) or kidney stones, to more serious issues like tumors or glomerular diseases. Given your history of urinary tract infections and the recent findings of blood in your urine, it is crucial to consider both infectious and non-infectious causes.

1. Further Investigations: Since you have experienced recurrent hematuria, it may be prudent to pursue additional diagnostic tests. Although your urologist mentioned that sometimes the cause of hematuria remains elusive, further imaging studies such as a CT urogram or MRI could provide more detailed information about the urinary tract. These imaging modalities can help identify any structural abnormalities, masses, or lesions that may not have been visible on previous ultrasounds or X-rays. Additionally, a cystoscopy, which involves direct visualization of the bladder and urethra, may be warranted to rule out any lesions or abnormalities in the bladder lining.

2. Left Flank Pain and Possible Conditions: The left flank pain you mentioned could be related to several conditions. While it is possible that it could be associated with a "floating kidney" (nephroptosis) or nutcracker syndrome (where the renal vein is compressed), these conditions are less common. Given your low BMI (15), it is essential to ensure that there are no anatomical abnormalities contributing to your symptoms. A thorough evaluation by a urologist or nephrologist may help clarify the cause of your flank pain and whether it is related to your kidney function or structural issues.

3. Weight Loss and Its Relation to Hematuria: Your weight loss of approximately 4 kg over a few months is concerning, especially in the context of ongoing health issues. While it is unlikely that the hematuria itself is directly causing the weight loss, it is essential to consider other potential underlying conditions that could be contributing to both symptoms. Conditions such as chronic infections, malignancies, or systemic diseases could lead to both hematuria and weight loss. Therefore, it is crucial to discuss this symptom with your healthcare provider to determine if further evaluation, such as blood tests or imaging, is necessary to rule out serious conditions.

In summary, while your urologist has advised you not to be overly anxious about the hematuria, it is essential to remain vigilant and proactive in your healthcare. Given the complexity of your symptoms, including recurrent hematuria, flank pain, and unexplained weight loss, further investigations are warranted. Engaging in open communication with your healthcare providers and advocating for your health will be crucial in navigating this situation effectively. It is always better to err on the side of caution when it comes to unexplained symptoms, and a thorough workup can provide peace of mind or lead to timely intervention if needed.

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