Haematuria

Definition

• Haematuria: Presence of blood in the urine.
• Classified as macroscopic (visible) or microscopic (detected on dipstick or microscopy).

Epidemiology

• Common clinical finding, with varied underlying causes.
• More concerning in patients >40 years due to increased risk of malignancy.

Causes

• Glomerular: Glomerulonephritis, IgA nephropathy, Alport syndrome.
• Stones: Kidney or bladder stones.
• Infection: UTI, tuberculosis, schistosomiasis.
• Neoplasms: Bladder cancer, renal cell carcinoma, prostate cancer.
• Medications: Warfarin, cyclophosphamide, rifampicin.
• Other: Trauma, exercise-induced, cystitis, prostatitis.

Clinical Presentation

• Macroscopic haematuria: Pink, red or brown urine.
• May be associated with dysuria, flank pain, fever, or weight loss.
• Clots may indicate bladder origin.

Investigations

• Urine dipstick: Quick initial test but needs confirmation.
• Urine microscopy: To quantify red cells and look for casts/cells.
• Ultrasound: Assess kidneys and bladder for masses, cysts, or stones.
• CT Urogram: Detailed imaging of the urinary tract.
• Cystoscopy: If bladder malignancy is suspected.

Management

• Directed by the underlying cause.
• Antibiotics for UTIs, surgery or lithotripsy for stones, etc.
• Referral to urology may be required for suspected malignancies or persistent unexplained haematuria.

Complications

• Anaemia due to chronic blood loss.
• Progression of undiagnosed underlying disease (e.g., malignancy).

Key Points

• Always take haematuria seriously as it may be the first sign of a significant pathology such as malignancy.
• Thorough history and examination are vital to ascertain the cause.

Haematuria is a symptom with a wide differential diagnosis. It’s essential to approach with a systematic assessment to exclude serious pathologies.