Blood in Urine: Causes, Concerns, and Next Steps - Internal Medicine

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Blood in urine, or hematuria, can be a concerning symptom that warrants thorough investigation. In your case, it appears that you initially experienced visible blood in your urine, which led to a diagnosis of a urinary tract infection (UTI). After treatment with antibiotics, your follow-up urine tests showed no signs of infection, but there were still red blood cells present in your urine.

The presence of red blood cells (RBCs) in urine can indicate several potential issues. A count of 5-10 RBCs per high-power field (HPF) is considered abnormal and can suggest various conditions, including:
1. Urinary Tract Infection (UTI): While your recent tests showed no infection, it's important to note that UTIs can sometimes resolve but still leave residual blood in the urine.

2. Kidney Stones: These can cause irritation and bleeding in the urinary tract, leading to hematuria.

3. Glomerular Disease: Conditions affecting the kidneys' filtering units can lead to blood in the urine.

4. Trauma: Any injury to the kidneys or urinary tract can result in bleeding.

5. Tumors: Both benign and malignant tumors in the urinary tract can cause hematuria.

6. Prostate Issues: In males, prostate enlargement or inflammation can also lead to blood in the urine.

Given that your doctor has recommended regular monitoring rather than immediate treatment, it suggests that they may not see an urgent concern at this moment. However, the presence of RBCs in your urine should not be ignored, especially since you previously experienced visible blood.

If you are still experiencing symptoms or have concerns about your health, seeking a second opinion is a reasonable course of action. A different physician may provide additional insights or recommend further diagnostic tests, such as imaging studies (like an ultrasound or CT scan) or a cystoscopy, to visualize the urinary tract directly.

In terms of your question about whether you have a serious condition, it's difficult to determine without further evaluation. While the absence of infection is a positive sign, the presence of RBCs could indicate an underlying issue that needs to be addressed.
In summary, while your current doctor may be taking a watchful waiting approach, it is entirely appropriate for you to seek further evaluation if you have ongoing concerns. Blood in urine can be a symptom of various conditions, some of which may require treatment, so staying proactive about your health is essential. Regular follow-ups and open communication with your healthcare provider are key to ensuring any potential issues are identified and managed promptly.