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Differential Diagnosis and Investigation of Haematuria

By Edited Jun 10, 2014 0 0

Haematuria the presence of blood in the urine

Presence of blood in the urine is known as haematuria. The bleeding can arise anywhere in the urinary tract system and can be serious or benign.  Haematuria can be classified as Macroscopic when blood is visible to the naked eye or Microscopic when the urine specimen needs to be looked under a high powered microscope to view the red cells in the urine.

The most common causes of haematuria include infection and stones within the urinary tract, tumour of the bladder, benign prostatic hypertrophy and cancer of the prostate. Infection can cause haematuria, examples  include cystitis, tuberculosis and schistosomiasis. Tumours arising in the urinary tract such as the kidney system, bladder and urethra as well as prostate can cause patients to experience blood in the urine.  

Inflammatory conditions such as glomerulanephritis,  IgA nephropathy and Goodpasture’s Syndrome can also cause haematuria. There are many other cause of haematuria, some of them include surgery of prostate and bladder, certain medication, structural abnormalities due to calculi.  Cancerous tumour cells can obstruct the flow of urine. When the urine is trying to pass through the ureter through the kidney, the tumour may be causing an obstruction and therefore the cells along the ureter are becoming damaged as the urine is flowing through it and hence why the patients end up having blood in the urine.

Red Flags for urinary symptoms

Symptoms of bleeding from the unrinary tract

Haematuria can occur in a patient where it is benign but certain signs and symptoms could indicate cancer or renal disease.  If the patient with haematuria and does not experience symptoms of frequency, urgency and dysuria then the patient is unlikely to have a urinary tract infection. If the same patient does not any abdominal pain either between the loin and groin then the patient is unlikely to have renal stones  either.  In this situation haematuria without abdominal pain becomes a red flag and could indicate bladder or renal cancer and urgent referral is necessary.

Blood in urine tests results

Other red flags of urinary symptoms which require urgent attention include painless acute retention of urine and a history of prolonged bladder outflow obstruction. The doctor should be suspicious of prostate cancer for men over the age of 40 who find it difficult to pass urine and therefore a rectal examination should be performed to check the prostate.

Investigation of haematuria

Gross haematuria differential diagnosis and investigation

Investigation of the cause of the haematuria is vital to determine which part of the urinary tract system has been effected so that the necessary management to the condition can be applied. A physical exam should be performed first which should include the prostate in the male and the female gynaecological organs if it is a woman. A urine sample should be sent off for cytology to look for the presence of red and white cells, bacteria, crystals, and the presence of protein.

Full blood count, erythrocyte sedimentation rate, serum urea, creatinine and electrolytes should be requested to find out the overall wellbeing of the patient and to see if there is any renal impairment. Malignancies and calculi can be seen using an intravenous urography or abdominopelvic radiography and ultrasound. If after this nothing can be found a cystoscopy can be performed, this involves inserting a thin fibre optic tube with a camera and a light source into the bladder via the urethra to look for any abnormalities. The cystoscope can be used to take biopsies of tissue if cancer is suspected and can also be used to remove small bladder stones.

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