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Blood in the Urine (cont.)

Exams and Tests

Regardless of whether you have microscopic or gross hematuria, your health-care provider will ask questions to try to discover the cause.

You will be asked about your medical condition and history, particularly whether you have ever had blood in the urine before.

You will be asked about what medications you take or have taken in the past, including over-the-counter drugs, illegal drugs or drugs of abuse, herbs, supplements, and other alternative products.

You will be asked whether you have had any recent illnesses, accidents, surgeries, or medical procedures or tests.
You may be asked whether you have traveled outside the United States.

You will be asked about your work history and about exposures to toxic chemicals.

You will be asked about your lifestyle and habits, including smoking, diet, and exercise.

You will be asked about your urinary habits and recent changes in your urinary habits.

Laboratory tests: After the initial examination, laboratory and imaging studies may be performed.

Urine "dipstick": This will probably be the first test performed in the emergency department or medical office. A strip of chemically treated paper is dipped into a cup containing a sample of your urine. The paper will show different colors to indicate the presence of blood, protein, glucose, or infection. Under certain conditions the dipstick can give a false-positive result for blood.

Urine analysis (urinalysis): A formal urinalysis usually follows the dipstick test. Urinalysis is more accurate and gives a better idea of what is causing the bleeding. This is usually not done in the doctor's office but at a laboratory where the doctor sends the urine. Protein in the urine, for example, signifies that a kidney problem is causing the hematuria. The urine is examined under a microscope to look for red blood cells and white blood cells (which signify infection) as well as other cells and materials that may be present in the urine.

Urine culture: A small amount of the urine is brushed on a special dish and placed in an incubator. Unusual bacterial growth indicates a urinary tract infection.

Imaging: There are several ways to visualize the urinary system, including ultrasound of the kidneys, intravenous pyelography, and CT scan.

Ultrasound, also known as sonography, uses high-frequency sound waves to "see" structures inside your body.

This likely will be one of the first imaging studies performed because it is simple and widely available.

Ultrasound is used in pregnancy because the test involves no radiation exposure that can damage the developing fetus.

It is useful in screening for kidney enlargement from an obstruction such as a stone, cancer, prostate enlargement, or strictures.

Intravenous pyelogram, or IVP, is an X-ray of the urinary tract.

A dye is first injected into your vein; the dye is filtered by your kidneys and provides contrast so the kidneys are easier to see.

A series of X-rays is taken over a 30-minute period, looking for blockages or problems.

This study is especially useful for evaluating the kidneys and ureter but less effective for the bladder, prostate, or urethra.

It can localize obstruction, stones, or a tumor.

IVP should be performed with care in older people and people with diabetes or preexisting kidney disease, because the contrast dye may bring on kidney failure.

CT scan is like an X-ray but gives much better detail.
- It is excellent for detecting stones in your urinary system.
- The test can be performed without contrast dye and is especially useful in people with preexisting kidney disease.

If stones and infection are ruled out, other tests are needed to look for less common causes of hematuria. Older people are at especially increased risk for more serious causes of blood in the urine. Anyone 40 years of age or older should have a medical evaluation to determine if cancer is present in the urinary system. This workup usually can be done on an outpatient basis.

Cystoscopy: This test is most likely to be performed by a specialist dealing with the urinary system (urologist).

A thin tube with a tiny camera on the end is passed through the urethra to visualize the bladder, prostate (in men), and ureters. You are first given medication to relax you and relieve the discomfort of the procedure.