What Causes Blood in Urine?
Symptoms of blood in the urine:
How could I know if my urine has blood inside?
Check yourself first. and note that:
- Changed urine color and painful urination are the main symptoms of blood in urine.
- Urinating not be painful unless blood clots in the urine present.
- Stingy Urination is evidence of injury.
- The color of the urine, in the case of haematuria is either pink, red, and not similar to the color of cola drink.
- A small amount of blood can change the color of your urine.
- Some cases there is no change in the color of urine in case of microscopic hematuria.
- When the color of your urine suspiciously about the presence of blood in the urine, it’s better to go to the laboratory to take a complete urine analysis.
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Where Blood in Urine Might Come From
How we can correlate Symptoms with Lab findings to know the reasons of bloody urine.
Laboratory finding in the urine analysis test:
Hemoglobin in urine without microscopic blood cells: common in physiological causes which are not a disease related, and occasionally hemolytic anemias.
Red blood cells few to many: not a specific reason as stones can drop few to no blood in urine, some urine crystals cause few microscopic blood cells in urine while some urinary crystals not.
Red blood cells many to over 100 cells/HPF: commonly seen in cases of advanced kidney inflammations and renal failure degrees, in addition to asymmetrical stones, parasites ova, calcium oxalates and uric acid crystals.
Macroscopic blood clots with over count RBCs/HPF: caused by some cancers or trauma of genitourinary organs
Can I know the cause of blood in my urine before visiting a doctor?
1-Have you felt a persistent urge to urinate with pain and burning while urination, and extremely strong-smelling urine.
Urine analysis result: have RBCs up to 20/hpf, pus cells, albumin, casts, and epithelial cells with stinky turbid fluid
Kidney infection medically termed pyelonephritis.
Pyelonephritis caused by bacterial infection of the kidney and accompanied with fever and flank pain/pain in the side of your tummy in addition to leakage of blood cells in urine (Pus and RBCs).
Medical term of inflammation of the wall of the bladder is cystitis and caused by bacteria which result in inflammation of bladder and bloody urine, blood cells in urine, and smelly odor.
Urethritis is the inflammation of urethra (the tube that carries urine out of the body)
Urethritis cause few to many RBCs per high power field; it’s often caused by a sexually transmitted infection (STI) such as chlamydia
All aspects of UTI can be turned into chronic phase and cause nephritis if prolonged without medication.
2-Blood cells in my urine with blockage of urination, excruciating pain, and frequent bleeding:
While kidney stones and bladder stones can cause bleeding and difficult urination, the stones may not stop urine passage or cause bleeding.
Some cases of kidney stones only show some red blood cells and few urine crystals with painless urination until blocking urine pass way.
3- I am a man in the middle age has difficult urination, RBCs in urine analysis and ultrasound show enlarged prostate.
Suggestive of benign prostatic hyperplasia, or BPH
A common condition in older men and have nothing to do with prostate cancer, where the prostate gland is pressing on the top of the bladder and cause problems such as difficulty urinating and frequent need to urinate with macroscopic and/or microscopic bleeding.
4-blood cells in urine male with urgent need to urinate and difficulty in passing urine, the Uls show enlargement in prostate.
Basically prostate inflammation by bacteria (prostatitis) can be the cause, decreased passing urine volume is due to enlargement of prostate which narrowing the urine passing through bladder and urethra, microscopic RBCs in the beginning which may be visible hematuria later.
Chronic Nonbacterial Prostatitis in men between the ages of 35 and 50, can lead to serious sexual and urinary problems if not treated. Chronic Nonbacterial Prostatitis causes moderate to marked blood in the urine or semen with frequent or urgent need to urinate, difficulty or straining to urinate, and pain or burning with urination and pain with ejaculation
Blood in urine due to blood abnormality
- High Blood Pressure is one of blood in the urine, although Blood pressure medications cause low RBCs in urine.
- ABO Incompatibility Reaction is a reason of appearance of blood in your urine, which symptoms begin in minutes with overall pain.
- Low Platelets count in CBC test causes blood in urine with bleeding from the rectum or blood in the stools, women experience heavy menstrual bleeding
- Sickle cell anemia cause hematuria in urine test. Which inherited red blood cells hemolysis.
- Paroxysmal nocturnal hemoglobinuria (PNH) is a rare inherited disorder that causes early breakdown of red blood cells lead to discoloration of urine as a major clue, unexplained blood clots and anemia, urine analysis not enough and for confirmation you need more tests to confirm the presence of the disease.
- Bloody urine results from absence of one or more of coagulation factors in cases like Hemophilia A, B (Christmas disease), C, and Von Willebrand disease, in which symptoms include prolonged bleeding time with unexplained bruises, nose bleeds, Also Hemophilia causes blood in the urine and blood in the stool.
- Porphyria a diseases of abnormal hemoglobin cause abnormal urine test results and checked up by many tests include: Urine test for fluorescence, porphobilinogen (PBG) urine test, and complete blood count (CBC)
- Hypercalcemia which means too much calcium in the blood and cause excessive urination with multiple blood cells in the urine fluid.
Blood in urine due to Blood vessel diseases (vasculitis):
- Wegener’s granulomatosis, which is a rare disease causes inflammation of the blood vessels,
- Polyarthritis nodosa, which is a disease in which cells attack arteries
Kidney diseases cause variable microscopic urinary bleeding.
Glomerulus is the main part of filtration system of the kidney, inflammation of the glomeruli called glomerulonephritis which can be caused due to many reasons:
Primary kidney function disorder, Systemic diseases, diabetes, IgA nephropathy (small renal capillaries infection), post strep infection or viral infection,
Blood in urine come from inflammation by injury, toxins, or hypersensitivity:
- Injury of kidney in contact sports cause visible blood in urine.
- Accidents that hitting kidney can cause blood cells in urine.
- Rhabdomyolysis is muscle fibers breakdown by injury or toxic chemicals and causes the release of myoglobin into the bloodstream which can cause kidney damage. Rhabdomyolysis causes dark urine with RBCs in urine, muscle weakness, and fatigue.
- Acute Hypersensitivity vasculitis is an inflammation or redness of the skin that occurs when you come in contact with an irritating substance, if get worse may cause kidney inflammation.
Blood in the urine by infection:
- Post Strep throat infection, a kidney inflammation and bleeding
- Reactive Arthritis (Reiter’s Syndrome) causes red blood cells moderate to marked which is caused by bacterial infection such as chlamydia or salmonella.
- Cervical Dysplasia by human papilloma virus (HPV) causes moderate to severe blood in urine fluid.
- Infective endocarditis is an infection in the heart valves or endocardium lead to gross pain includes blood cells in urine test.
- Aspergillosis is an infection, allergic reaction, or fungal growth caused by the Aspergillus fungus in people with a weak immune system. Aspergillosis symptoms include blood in your urine and/or less urine
Kidney inflammation by autoimmunity:
- Post Streptococcal infection which may be have the name “nephrotic syndrome”, casts in urine are characteristic.
- Immune Lupus Nephritis by SLE (Systemic lupus erythematosus) is a cause in bloody urination.
- Goodpasture’s syndrome, a rare autoimmune disease in which antibodies attack your kidneys and lungs.
- Goodpasture syndrome is a rare life-threatening autoimmune disease of the lungs and the filtering units in the kidneys. Goodpasture disease can lead to bleeding in the lungs, kidney failure, and even death.
- Amyloidosis, which occurs when abnormal proteins that can cause harm accumulation in your organs and tissues
- Alport syndrome is a genetic disorder affects the filtration membrane of kidney’s glomeruli, People with Alport syndrome experience progressive kidney function failure in addition to hear loss, and vision abnormalities. Most Alport patients have blood in their urine (hematuria) and protein in urine especially in late stages.
Drug induced kidney inflammation cause bloody urine with altered color:
- Heavy use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may also be a risk factor.
- Anti-cancer drug as cyclophosphamide (e.g. Cytoxan) cause bleeding in urine, which you can see.
- Antibiotics as Penicillin cause blood to appear in urine.
- Anticoagulant, in contrast aspirin and the blood thinner heparin cause urinary bleeding, and show blood cells up to over count in urine test results.
Lower urinary tract inflammation is a reason of blood in urine analysis:
Urethral Stricture cause bloody urine in which urethra narrows and restrict urine flow.
Acute Unilateral Obstructive Uropathy causes blood cells in the urine due to blockage of urine in kidney by stones.
Physiological blood in urine (natural hematuria)
- Vigorous exercise cause natural hematuria occur in some people practicing training exercises as aerobics and runners, some pathology books call that “march hematuria”, suggested causes are dehydration which concentrate urine fluid, hitting bladder, or red blood cells leak their hemoglobin into urine cause hematuria.
- Intense workout causes gross hematuria with changed urine color to reddish or dark yellow.
- Beeturia: common term for false positive hematuria in which certain foods cause falsely blood in urine test such as beets, rhubarb and berries, which is due to food dyes and non-illness hematuria.
- Excessive and abnormal menses in women cause blood in urine test, but not due to a cancer or other diseases.
Injury and Accidents cause mild to moderate bloody urine:
- Hitting testicles or penis causes blood in man urine.
- Hitting female urethra by accident or during sex cause mild bleeding.
- Tight clothes may cause mild microscopic hematuria.
Tumors lead to bleeding in the urine:
Visible bleeding in urine analysis is strongly suspicions for cancers of urinary tract organs (e.g. kidney, bladder, or prostate), visual blood in urine for possible cancers suggest late stage.
- Renal cell carcinoma (RCC) is also called hypernephroma, renal adenocarcinoma, or renal or kidney cancer. It’s the most common kind of kidney cancer found in adults. RCC causes vision problems, persistent pain in the side, and excessive hair growth (in women)
- Kidney cancer cause gross blood in the urine analysis and a lump in the abdomen discovered visually or by medical scan.
- Acquired Cystic Kidney Disease (ACKD) causes blood in the urine with urinary tract infection, kidney stones, and pain in the sides
- Malignant Neoplasm (tumor) of the Ureter may cause gross bleeding in urine, ureter is the tube that connects the kidneys to the bladder.
- Leukemia of different types may cause blood in your urine of variable degrees.
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