Hematuria means the presence of blood in the urine; this is not always visible with the naked eye (microscopic hematuria), being usually discovered after some routine tests.

There are many causes for hematuria, and most of them are not serious, as it follows: urinary infection, enlarged prostate in older men, kidney or bladder stones, kidney infection (pyelonephritis), prostate infection, kidney disease, trauma at kidneys’ level (for example, after practicing a sport), bladder cancer or kidney cancer, anticoagulant/anti-inflammatory medication, intense physical exercise. Keep in mind that certain medications, as well as certain foods, including beetroot and berries, can cause a red color in the urine, which will disappear within a few days.

The risk factors that increase the chances of hematuria are: age (men over 50), a recent infection (viral or bacterial), family history of kidney disease, use of certain drugs (non-steroidal anti-inflammatory drugs and antibiotics), intense physical exercise (long distance runners).

Fortunately, only 2-3 cases out of 100 that present microscopic hematuria have cancer, but the probability increases when blood is visible in the urine with the naked eye (macroscopic hematuria), especially when the patient is a smoker. When the lab tests detect microscopic hematuria, it is usually recommended to repeat the urine analysis; when the presence of proteins in the urine is identified, additional investigations are required.

Macroscopic hematuria produces pink or red urine due to the presence of erythrocytes (red blood cells). A small amount of blood is needed for the color to appear, and the bleeding is usually not painful, except when you urinate blood clots.

For a correct diagnosis of the cause of hematuria, blood tests will be needed to assess the functioning of the kidneys, a cystoscopy (a procedure that helps the doctor look inside the bladder), as well as some imaging tests (tomography, MRI or ultrasound to analyze the inner and outer parts of the kidneys, ureters and bladder). When the cause is not discovered, it is recommended to repeat the urinalysis at intervals of 1 year, respectively 2 years.

The cause of the hematuria will determine the type of treatment you will receive. In the case of a urinary infection, the doctor can prescribe antibiotics to eliminate the causative bacteria. If there are involved kidney stones,  the urologist will recommend drugs that help you eliminate them or an ultrasound-based intervention that breaks down the stones into smaller pieces, which will be easily removed (extracorporeal shock wave lithotripsy), as well as a minimally invasive endoscopic intervention. In the case of an enlarged prostate causing hematuria, drugs will be prescribed and sometimes surgery is necessary.

It should be remembered that not treating the cause of hematuria in time can lead to the worsening of the respective disease. Thus, if it is cancer, tumors can advance to the point where treatment becomes difficult. And untreated infections can eventually lead to kidney failure.