Blood in Urine: Kidney Stones and Potential Risks

Q: Blood in Urine: Kidney Stones and Potential Risks

Hello： <br>1. <br>Based on your clinical experience, could the continuous passage of stones indicate a serious underlying condition? --> It is possible, especially considering your age. <br>There is also a possibility that kidney stones are causing friction and damaging blood ves

Hematuria due to kidney stones?

Hello Doctor, I have several kidney stones of various sizes in both of my kidneys, with the largest being approximately 1.2 cm.
I haven't addressed this issue for over two years during the pandemic and have been relatively fine.
However, starting last November, I have experienced stones getting lodged in my ureter almost every month.
By June of this year, I had undergone extracorporeal shock wave lithotripsy five times.
A month ago, I went to the hospital due to visible hematuria (dark red urine).
I initially thought it was another stone blockage, but X-rays and an intravenous pyelogram (IVP) did not reveal any stones.
The doctor subsequently arranged for a CT scan and urine cytology, which also did not show any significant lesions.
The hematuria has persisted for a month, sometimes appearing darker and sometimes lighter, but the color has consistently seemed abnormal.
I have noticed that when I am quietly at home, the color is lighter, while after some activity, even mild ones like shopping, the color becomes darker (deep tea color or even dark red).
Additionally, if I hold my urine for a long time, the color also deepens.
I explained my situation to the doctor, who suggested that the stones might be scraping the blood vessels in my kidneys, and if they scrape larger vessels or go deeper, the bleeding could be more significant.
I would like to ask the doctor: 1.
Based on your clinical experience, could the continuous passage of stones indicate a serious underlying condition? 2.
Is frequent extracorporeal shock wave lithotripsy harmful to the body? Specifically, does the use of radiation to locate stones have any adverse effects? 3.
Is it really possible for stones remaining in the kidneys to cause prolonged bleeding due to friction damaging blood vessels? I have also had three X-rays in the past month, and no stones have been detected.
4.
Can the color of hematuria indicate whether it is caused by a tumor? For example, would hematuria caused by a tumor appear darker, lighter, or bright red? I would greatly appreciate it if you could take the time to address my concerns.
Thank you!

hshikuang, 40~49 year old female. Ask Date: 2023/09/05

Dr. Du Shixi reply Urology

Hello:
1.
Based on your clinical experience, could the continuous passage of stones indicate a serious underlying condition? --> It is possible, especially considering your age.
There is also a possibility that kidney stones are causing friction and damaging blood vessels.
2.
Could frequent extracorporeal shock wave lithotripsy (ESWL) be harmful to the body? Specifically, since the procedure requires radiation to locate the stones, could this radiation have an impact on health? --> It should not be harmful; however, if the treatment is not effective, you might consider hospitalization at a medical center for alternative treatment.
Lifestyle changes are also important to prevent the stones from growing larger.
3.
Is it really possible for stones remaining in the kidneys to cause prolonged bleeding due to friction damaging blood vessels? --> Yes, it is possible.
In the past month, I have undergone three X-rays, and there have been no indications of stones passing.
4.
Can the color of blood in urine help determine if it is caused by a tumor? For example, would blood in urine caused by a tumor appear darker, lighter, or bright red? --> It cannot be determined solely by color; however, very dark urine may indicate old blood being expelled, while bright red could suggest fresh bleeding.
Wishing you good health.

Reply Date: 2023/09/05

More Info

Blood in urine, or hematuria, can be a concerning symptom, especially in the context of kidney stones. Your situation, where you have multiple kidney stones and have experienced recurrent episodes of blood in your urine, raises several important questions regarding potential underlying conditions, the implications of frequent treatments, and the nature of the hematuria itself.

1. Potential Serious Conditions: The presence of kidney stones and recurrent hematuria can sometimes indicate more serious underlying conditions. While kidney stones themselves can cause bleeding by irritating the urinary tract, persistent blood in the urine, especially if it is not associated with visible stones on imaging, may warrant further investigation. Conditions such as urinary tract infections, tumors (benign or malignant), or other renal pathologies could be responsible for the bleeding. It is essential to follow up with your healthcare provider for comprehensive evaluations, including imaging studies and possibly cystoscopy, to rule out these possibilities.

2. Impact of Frequent Extracorporeal Shock Wave Lithotripsy (ESWL): While ESWL is generally considered safe, frequent treatments can have cumulative effects. The use of radiation during imaging studies, such as X-rays and CT scans, does pose a risk, albeit small, particularly with repeated exposure. It is crucial to balance the need for imaging with the potential risks. If ESWL is not effectively managing your stones, discussing alternative treatment options with a urologist may be beneficial. These could include ureteroscopy or percutaneous nephrolithotomy, which might be more effective for larger or more complex stones.

3. Prolonged Bleeding from Stones: It is indeed possible for kidney stones to cause prolonged bleeding. Stones can irritate the lining of the urinary tract, leading to micro-tears in blood vessels. If a stone is stationary and causing ongoing irritation, it could result in chronic hematuria. However, if imaging studies are consistently negative for stones, it may be necessary to consider other causes of the bleeding, such as vascular malformations or other renal issues.

4. Color of Blood in Urine and Tumor Indicators: The color of blood in urine can vary based on several factors, including the source of the bleeding. Dark red or tea-colored urine often indicates older blood, while bright red blood may suggest fresh bleeding. However, the color alone is not a reliable indicator of the cause. Tumors can cause hematuria, but they may not always present with a specific color. A thorough evaluation, including imaging and possibly a biopsy if indicated, is necessary to determine the cause of hematuria.

In conclusion, your symptoms warrant careful monitoring and further investigation. It is essential to maintain open communication with your healthcare provider, who can guide you through the necessary tests and treatment options. Lifestyle modifications, such as increased hydration and dietary changes, may also help manage kidney stones and reduce the risk of recurrence. Always prioritize your health and seek immediate medical attention if you experience significant changes in your symptoms.

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