Blood in Urine: Causes and Concerns for Kidney Health

Hematuria

Hello Dr.
Yang, I have been feeling like I have a slight fever these past few days, and I noticed that I have visible hematuria.
It shouldn't be the new flu, right? My kidneys have not been in good condition; I have had hematuria (not visible) since childhood.
About 4.5 years ago, after experiencing vomiting and diarrhea, I had hematuria.
When I went for an examination, they found hematuria and proteinuria.
The doctor diagnosed me with IgA nephropathy, stating that the hematuria would disappear after three days.
After three days, the urine test showed hematuria but no proteinuria.
The doctor advised me to take fish oil and to have regular check-ups.
Now that I am experiencing hematuria again, could it be due to the same underlying cause? Has my condition worsened? Thank you.

Ya Ya, 20~29 year old female. Ask Date: 2009/09/24

Dr. Yang Weishun reply Internal Medicine

To confirm whether it is indeed IgA nephropathy, the most reliable method is to perform a kidney biopsy for diagnosis.
IgA nephropathy can indeed present with visible hematuria following respiratory infections, but it is also possible to detect microscopic hematuria during asymptomatic periods.
In fact, what affects the renal function of patients with IgA nephropathy is not the degree or frequency of hematuria, but rather the level of proteinuria and hypertension.
Therefore, there is no need to be overly concerned about hematuria, but it is important to regularly monitor proteinuria and blood pressure, as well as to avoid infections and excessive fatigue.

Reply Date: 2009/09/24

More Info

Hello! It sounds like you are experiencing a concerning situation with your health, particularly with the recurrence of blood in your urine (hematuria) and a history of kidney issues. Let's break down your concerns regarding the potential causes of hematuria, especially in the context of your previous diagnosis of IgA nephropathy, and what steps you might consider taking.

Understanding Hematuria: Causes and Concerns
Hematuria can arise from various conditions affecting the urinary tract, including the kidneys, ureters, bladder, and urethra. Given your history of IgA nephropathy, it's essential to consider how this condition might relate to your current symptoms. IgA nephropathy, also known as Berger's disease, is characterized by the deposition of IgA antibodies in the glomeruli of the kidneys, leading to inflammation and damage. This condition can cause episodes of hematuria, often triggered by infections or physical stress.

In your case, the presence of visible blood in your urine, especially following a period of fever, raises several possibilities:
1. Infection: Urinary tract infections (UTIs) can cause hematuria and may also present with fever. Given your symptoms, it would be prudent to have a urinalysis and possibly a urine culture to check for any bacterial infections.

2. IgA Nephropathy Flare-Up: Since you have a history of IgA nephropathy, the recurrence of hematuria could indicate a flare-up of this condition. Stressors such as infections, dehydration, or even vigorous physical activity can exacerbate the symptoms.

3. Other Renal Issues: Conditions such as kidney stones, glomerulonephritis, or even tumors can also lead to hematuria. Given your previous experiences, it is crucial to rule out these possibilities through appropriate imaging studies and laboratory tests.

4. Systemic Conditions: Sometimes, systemic diseases like vasculitis or other autoimmune disorders can affect the kidneys and lead to hematuria.

Next Steps and Recommendations
1. Consult Your Nephrologist: Given your history and the recurrence of symptoms, it is vital to consult with your nephrologist. They can perform a thorough evaluation, including blood tests, urinalysis, and possibly imaging studies like an ultrasound or CT scan to assess kidney structure and function.

2. Monitor Symptoms: Keep track of any additional symptoms you may experience, such as changes in urination frequency, pain, or any other systemic symptoms like fever or fatigue. This information can be valuable for your healthcare provider.

3. Lifestyle Modifications: Staying well-hydrated and maintaining a balanced diet can support kidney health. If you are taking supplements like fish oil, ensure that they are appropriate for your condition and discuss them with your doctor.

4. Regular Follow-Up: Since you have a chronic kidney condition, regular follow-ups with your healthcare provider are essential to monitor kidney function and manage any complications that may arise.

5. Avoid Self-Diagnosis: While it can be tempting to connect your current symptoms with past diagnoses, it's crucial to rely on medical evaluations for accurate diagnosis and treatment. Conditions can evolve, and new issues may arise that require different management strategies.

In summary, while your previous diagnosis of IgA nephropathy could explain the hematuria, the recurrence of symptoms warrants a comprehensive evaluation to rule out other potential causes. Prompt medical attention is essential to ensure your kidney health is monitored and managed effectively. Please reach out to your healthcare provider as soon as possible to discuss your symptoms and get the appropriate care.

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