Hematuria (Blood in Urine)

Kumud P Mehta
Hematuria (Blood In Urine) - Patient Education
My child has red coloured urine, What does it signify?
Red coloured urine suggestive of blood in the urine. However, every pink/red/brown coloured urine may not be due to blood in urine. Ingestion of coloured sweets, beetroot, drugs (Rifampicin, anantituberular drug causes orange coloured urine; Multivitamins may cause yellowish colour of urine), hemoglobin or myoglobin can cause red urine.
The colour of the urine may give a clue to the cause:
- Cola coloured urine is suggestive of a kidney disease. It may be associated with puffiness of eyes and increased blood pressure.
- Bright red coloured urine, especially if seen at the end of urination is due to bleeding from the urinary bladder or from lower urinary tract.

How do you determine that the red coloured urine is due to presence of blood in urine?
A simple urine test can determine the cause of red urine. Either a microscopic examination of the urine in a pathology laboratory or a strip test can determine whether red urine is due to bleeding. However, the strip test may also be positive in case of presence of myoglobin or hemoglobin in urine. Red urine due to other causes will have a negative strip test.

Hence, the best way to determine the cause would be a simple urine examination under the microscope.

What are the causes of blood in urine?

The presence of blood in urine signifies bleeding from the urinary system. It can be from anywhere right from kidneys ureters (tubes that connect kidneys to the urinary bladder), urinary bladder and the urethra (tube that transmits urine from the bladder to the urinary opening on the body). Rarely, bleeding may be due to a bleeding disorder (eg Hemophilia etc).

How do you treat a patient with red urine?
First and foremost, it is necessary to determine the cause of bleeding for which a battery of tests may be required. Patient’s urine may be sent for examination and blood may be collected for a few tests (e.g ASO time, serum C3 , HbsAg, urine culture etc) depending upon the clinical features which the patient presents with sometimes, a 24 hour urine sample may be required, where urine passed over 24 hours is collected in a container and tested. Depending upon the cause, an ultrasound of the kidneys and pelvis maybe required.

Some causes of blood in urine (also called Hematuria) are transitory like Acute post infectious glomerulonephritis, renal stones etc which subside after sometime. Other conditions may lead to persistent bleeding, which may not be visible to the naked eye, but can be detected by microscopic examination. Hence, a urine examination may be done every monthly till at least, last 3 samples of urine are normal.

The treatment of blood in urine varies with the cause. In acute post infectious glomerulonephritis, the treatment is the complication bed rest, antihypertensives to lower the B.P and antibiotics. Acute pyelonephritis may require intravenous antibiotics.

What precautions can we follow to ensure good health of our child?
A child with acute episode of bleeding may require bed rest till the episode tides over (again depending upon the cause). However, a child with persistent bleeding can usually lead a normal life till complications of the kidney disease do not develop.

If my child has persistent bleeding, what can be done?
If your child has visible bleeding for more than 2-4 weeks after the 1st episode or has persistent microscopic bleeding for more than 12 months, then a kidney biopsy may be required to determine the cause and further management. In case, the child has recurrent episode of bleeding, then also a kidney biopsy is required. Family members may also be screened for blood in urine and hearing tests maybe done. In addition, further blood tests may be required. However, biopsy can confirm most of the diseases. If biopsy is normal and there is a familial tract of bleeding, then it has a good prognosis.

Rarely, tests like IVP & cystoscopy maybe required for the diagnosis. Again,the treatment depends upon the cause of bleeding?

Since, my child has persistent bleeding in urine, won’t he require a vitamin or iron supplements?
Microscopic bleeding of long standing does not usually lead to a low hemoglobin or decreased vitamin stores, hence the child may not require any hematinics, tonic or vitamin supplements.

Hematuria (Blood in Urine) Hematuria (Blood in Urine) 08/01/2015
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