Hematuria (blood in the urine)

Overview

Hematuria is the presence of red blood cells in the urine.

• Macroscopic hematuria — the urine looks pink, red or brown.
• Microhematuria — the blood is not visible to the eye and is detected only on a urine test.

Red urine does not always mean blood: the same color can come from beets, some foods with dyes or some medicines. That is why color alone is not enough — it must be confirmed with a test.

Possible causes

• urinary infections
• stones in the kidneys or urinary tract
• kidney diseases (e.g. glomerulonephritis)
• benign enlargement of the prostate in men
• trauma or very intense physical activity
• tumors of the kidneys or the bladder
• contamination of the sample with menstrual blood

Hematuria does not automatically mean cancer, but it should not be ignored — especially when it is visible and painless, in people over 40 or in smokers.

How it is assessed

The doctor asks when it appeared, whether there was pain or burning on urination, about medicines, smoking and occupational exposure to chemicals.

Possible steps:

• urinalysis with microscopy — confirms the finding
• urine culture — if infection is suspected
• creatinine and protein in the urine — for kidney function
• ultrasound of the kidneys and the bladder

Depending on individual risk and the type of hematuria, specialized urological exams may also be recommended — such as cystoscopy (looking at the bladder with a camera) or CT urography. Not every patient needs the same package of tests.

If you take blood thinners

Anticoagulants and antiplatelet drugs can increase bleeding, but they do not explain hematuria on their own: it must be evaluated in the same way as in people who do not take them. Do not stop the treatment on your own; tell the doctor who prescribed it.

After an infection

When the blood is linked to a documented urinary infection, the doctor may ask you to repeat the urine test after treatment. If hematuria continues or recurs, further investigation is needed. The absence of pain does not mean the absence of a problem.

Every episode of visible blood in the urine should be reported to your doctor, even if it happens only once.