Hematuria: Causes, Follow-Up, and When to Seek Help

Hematuria

Previously, during a routine health check at my company, the urine test showed a positive result for occult blood (+) (this was at the end of my menstrual period), while all other reports were normal.
However, after a retest, it still showed positive.
I consulted a urologist who performed kidney and bladder ultrasounds and a venous urography.
During the ultrasound, I was informed that my left kidney appeared slightly swollen, and I was advised to discuss this further with the physician during my follow-up appointment (as the technician and the physician were not the same person).
Subsequently, I underwent a venous urography (I believe that is the correct term; it involves the injection of a contrast agent), which returned normal results.
However, the physician did not provide much feedback and simply recommended regular follow-ups.
While sipping on his Starbucks, he called in the next patient.

I would like to ask the following questions:
A) Does kidney swelling have any relation to excessive bladder distension? The ultrasound required me to have a full bladder, but I am unsure what constitutes "full." I drank about one and a half small bottles (600cc each) of bottled water from a convenience store and had to urinate before the tests.
After the tests, I urinated three more times before leaving the hospital, which was within about half an hour, and the volume was similar to my usual bathroom visits.

B) What additional tests should be conducted for the positive urine occult blood?
C) What specific items should be monitored during regular follow-ups? Which department should I consult, nephrology or urology? I recently had a urine test at a general health check center, and again, there was a positive reaction for occult blood (about six months after my last consultation).
I had previously asked an internist about this, and the doctor mentioned that a single positive result is minor and not concerning, but the persistent occurrence is troubling me.

D) Can a general urology clinic perform these tests? I found that a lot of time at the large hospital was spent waiting, but it seems that general urology clinics primarily focus on sexually transmitted infections.
I want to confirm this as I have many questions.
Thank you for taking the time to respond.

Amanda, 30~39 year old female. Ask Date: 2009/06/27

Dr. Liu Jianting reply Urology

Many tests have been conducted, and all results are normal, so there should be no issues.
A: Renal enlargement does not necessarily indicate pathology, and the venous urinary tract examination is normal, which is unrelated to urinary retention.
B: If there is hematuria, it is advisable to visit a nephrologist or urologist for follow-up every three months.
C: First, perform a urinalysis and then an ultrasound.
D: If the examination equipment is adequate, there should be no problems.

Reply Date: 2009/06/27

More Info

Hematuria, or the presence of blood in urine, can be a concerning symptom that warrants thorough investigation. Understanding its causes, follow-up protocols, and when to seek medical help is crucial for effective management.

A) Impact of Urinary Distension on Kidney Health
You mentioned experiencing urinary distension during your ultrasound examination. While it is essential to have a full bladder for certain imaging tests, excessive distension can potentially lead to discomfort or complications. However, a slightly distended bladder is generally not harmful. The ultrasound technician typically instructs patients to drink a specific amount of water to ensure the bladder is adequately filled for optimal imaging. If you drank 900cc of water and felt the need to urinate before the test, it is likely that your bladder was adequately distended for the ultrasound.
In your case, the ultrasound indicated some swelling in the left kidney. This could be due to various factors, including urinary obstruction, infection, or other underlying conditions. It is essential to discuss these findings with your physician to determine the cause of the swelling and whether it is related to your urinary habits or other medical issues.

B) Further Investigations for Hematuria
Since you have had persistent hematuria, additional tests may be warranted to identify the underlying cause. Common investigations include:
1. Urine Culture: To check for urinary tract infections (UTIs).

2. CT Urogram: A more detailed imaging study that can help visualize the urinary tract and identify stones, tumors, or other abnormalities.

3. Cystoscopy: A procedure where a thin tube with a camera is inserted into the bladder to directly visualize the bladder and urethra.

4. Blood Tests: To assess kidney function and check for other potential causes of hematuria.

Your healthcare provider may recommend these tests based on your specific symptoms and medical history.

C) Follow-Up Protocols
Regular follow-up is essential for monitoring hematuria, especially if it persists. The follow-up may include:
- Repeat Urinalysis: To monitor for the presence of blood or other abnormalities.

- Imaging Studies: Depending on your symptoms and previous findings, your doctor may recommend periodic ultrasounds or CT scans.

- Consultation with a Urologist: If you have not already done so, a urologist specializes in urinary tract disorders and can provide targeted care.

You should continue to see a urologist for ongoing management of hematuria, as they can offer specialized insights into your condition.

D) General Urology Clinics vs. Specialized Centers
General urology clinics can indeed perform evaluations for hematuria. While some clinics may focus on specific areas like sexual health, many urologists are well-equipped to handle a range of urological issues, including hematuria. If you find that large hospitals have long wait times, seeking care at a smaller, specialized urology clinic may be a viable option. Just ensure that the clinic has the necessary diagnostic tools and expertise to address your concerns.

Conclusion
Persistent hematuria should not be ignored, and it is essential to follow up with your healthcare provider to determine the underlying cause. Regular monitoring and appropriate testing can help manage your condition effectively. If you have further concerns or if symptoms worsen, do not hesitate to seek immediate medical attention. Your health is paramount, and understanding your condition is the first step towards effective management.

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