Persistent Hematuria: Causes and Next Steps for Patients

Q: Persistent Hematuria: Causes and Next Steps for Patients

Hello： Patients with occult blood should be evaluated for the underlying cause, but often no specific reason can be identified. <br>If there are chronic conditions such as hypertension or diabetes, the likelihood of this symptom increases. <br>Generally, if no cause is found, a f

Hematuria issues

Hello, doctor.
I would like to inquire about my condition.
Approximately three years ago, I started having blood tests and urine tests, and the urine tests consistently showed trace blood (+) with red blood cells ranging from 10 to 20/HPF.
This has been ongoing for a long time.
Recently, I underwent a self-paid blood test, and the urine still showed a trace of blood.
Last year, I had various kidney blood tests, stone tests, bladder examinations, and kidney ultrasounds at a medical center, all of which returned normal results.
However, they could not determine the cause of my hematuria, which makes me very worried that I might have some disease or cancer.
Given that all the tests are normal, why do I still have persistent hematuria? It's not just once or twice; it happens every time I get tested.
What should I do? Should I request further examinations from my doctor? Or could the hematuria be related to any medications I am taking?

Zhang Mou, 50~59 year old female. Ask Date: 2021/06/16

Dr. Du Shixi reply Urology

Hello: Patients with occult blood should be evaluated for the underlying cause, but often no specific reason can be identified.
If there are chronic conditions such as hypertension or diabetes, the likelihood of this symptom increases.
Generally, if no cause is found, a follow-up examination is recommended in six months to a year.
If there is visible hematuria, it is important to return for a consultation immediately (this is the principle).
It is advisable to maintain adequate hydration, especially for those with chronic conditions.
Wishing you good health.

Reply Date: 2021/06/16

More Info

Persistent hematuria, or the presence of blood in urine, can be a concerning symptom for many patients, especially when it has been ongoing for an extended period. Understanding the potential causes and the next steps in management is crucial for alleviating anxiety and ensuring appropriate care.

Causes of Persistent Hematuria
1. Urinary Tract Infections (UTIs): While you mentioned that previous tests have ruled out infections, it's worth noting that UTIs can sometimes be intermittent. Symptoms may not always be present, and further testing might be necessary if you suspect a UTI.

2. Kidney Stones: Although you have undergone tests for kidney stones, they can sometimes be missed, especially if they are very small or located in areas that are difficult to visualize on imaging studies.

3. Glomerular Disease: Conditions affecting the glomeruli (the filtering units of the kidneys) can lead to hematuria. This includes diseases like IgA nephropathy or other forms of glomerulonephritis.

4. Bladder or Kidney Tumors: While less common, tumors in the bladder or kidneys can cause blood in the urine. Given your concern about cancer, this is a possibility that should be considered, especially if you have risk factors or symptoms such as weight loss or changes in urinary habits.

5. Medications: Certain medications, including anticoagulants and some pain relievers, can lead to hematuria. It’s important to review any medications you are taking with your healthcare provider.

6. Trauma: Any recent trauma to the kidneys or bladder can result in blood in the urine.

7. Other Conditions: Systemic diseases such as lupus or vasculitis can also present with hematuria.

Next Steps for Patients
Given that you have already undergone extensive testing, it is understandable to feel frustrated and anxious about the persistent hematuria. Here are some recommended steps you can take:
1. Follow-Up with a Specialist: If you haven’t already, consider seeing a urologist or nephrologist who specializes in urinary tract disorders. They may have additional insights or testing options.

2. Request Further Testing: You might want to discuss the possibility of more advanced imaging studies, such as a CT scan of the abdomen and pelvis, which can provide a more detailed view of the urinary tract. Cystoscopy, a procedure where a thin tube with a camera is inserted into the bladder, can also be helpful in visualizing the bladder lining directly.

3. Review Medications: Discuss all medications and supplements you are taking with your doctor. They can help determine if any of these could be contributing to your hematuria.

4. Monitor Symptoms: Keep a detailed record of any additional symptoms you may experience, such as changes in urination, pain, or any other unusual signs. This information can be valuable for your healthcare provider.

5. Consider a Second Opinion: If you feel your concerns are not being adequately addressed, seeking a second opinion can provide reassurance and potentially uncover new avenues for investigation.

Conclusion
Persistent hematuria can be a complex issue with various potential causes. While it is understandable to worry about serious conditions such as cancer, many cases of hematuria are benign. Continued communication with your healthcare provider, thorough follow-up, and possibly further testing are essential steps in managing your health. Remember, you are your best advocate, and it is important to voice your concerns and seek the care you need.

Similar Q&A

Understanding Persistent Hematuria: Diagnostic Challenges and Management

Hello, Doctor. Since the end of April, when I first noticed blood in my urine, I went to a general clinic and was diagnosed with right-sided hydronephrosis (ultrasound and X-ray at that time did not reveal any stones). I was advised to drink more water, and I started consuming ov...

Dr. Liu Mingyue reply Urology
Hello: If you ask me for a reference, the relationship between urinary tract infections and hydronephrosis is minimal. It is essential to focus on treating the urinary tract infection, and in addition to continuing medication, you must pay attention to lifestyle details as much a...

Persistent Visible Hematuria: Causes and Diagnostic Insights

Hello Doctor, I have been experiencing hematuria for a month, and the color is dark red. There is not much pain. When I first noticed it, I went to the hospital for a urinalysis, which showed numerous red blood cells, 3+ occult blood, and 20-25 white blood cells, but no bacteria ...

Dr. Xu Wencang reply Urology
You can discuss with your physician and consider undergoing a cystoscopy.

Understanding Hematuria: Possible Causes and Further Testing Options

In the past month, there have been symptoms of hematuria, with occasional blood clots in the urine. Kidney ultrasound, intravenous pyelography, and cystoscopy have shown no abnormalities. Which diseases can be ruled out, and which diseases still require further testing for confir...

Dr. Weng Wenzhen reply Urology
Hematuria is typically classified into medical and surgical types. Medical hematuria primarily includes infections, various types of glomerulonephritis, and nephrotic syndrome, which are mainly treated with medical management. Surgical hematuria primarily includes conditions such...

Navigating Urology Concerns: Seeking Guidance for Persistent Hematuria

Hello, Director Lin... I apologize for taking up your valuable time... Please bear with me... I am a helpless patient... This month, I have been following up at a medical center in the south regarding hematuria that was detected seven years ago at Taoyuan Min-Sheng Hospital. It s...

Dr. Lin Hexing reply Urology
Hello, thank you for your inquiry. I would like to address your question and provide the following suggestions: Regarding what you referred to as urinary occult blood, it is debatable whether the expenditure of energy and healthcare costs is justified. Further investigation shoul...