Red Blood Cells (RBCs) in Urine: Defination, Symptoms, Causes, diagnosis and Treatment

The presence of RBCs in urine, known as hematuria, can be caused by a variety of factors including urinary tract infections, kidney stones, and kidney disease. Hematuria can be microscopic or visible to the naked eye, and if you are experiencing it, it is important to see a healthcare provider for evaluation and diagnosis. Treatment will depend on the underlying cause of the hematuria.

Introduction:

Hematuria is a medical condition characterized by the presence of red blood cells in the urine. It can be caused by a variety of factors, including urinary tract infections, kidney stones, and kidney disease. Hematuria can be either microscopic, where the blood is not visible to the naked eye, or gross, where the urine appears reddish or brownish due to the presence of blood. Hematuria can be a symptom of a serious underlying medical condition, so it is important to seek medical evaluation and diagnosis if you experience it. Treatment for hematuria will depend on the underlying cause.

Alternative Names:

1. Urinealysis
2. Urine Analysis
3. Urine Microscopic examination
4. Hematuria
5. Microscopic hematuria
6. Gross hematuria
7. Hemoglobinuria
8. Blood-tinged urine
9. Hematuria without proteinuria (when there is blood in the urine but no protein)
10. Isolated hematuria (when there is blood in the urine but no other symptoms or abnormalities)

Type of urine samples:

• Random sample:
  This is a diluted urine sample and may give an inaccurate interpretation of patient health. But is best to do microscopy to evaluate WBC or RBC.
• First Morning sample:
  This is the best sample for microscopy and urine analysis. This is the concentrated urine because of urine remained throughout the night in the urinary bladder. This will contains an increased concentration of analytes and cellular elements. Urine must have remained in the bladder for 8 hours is considered as the first-morning sample.
• Urine for sugar (Postprandial 2 hours):
  Postprandial 2 hours sample collected after 2 hours of high carbohydrate diet. 
• Midstream clean catch urine:
  This sample is needed for the culture and sensitivity of urinary infection. The patient is advised to clean the urethra, then discard the first few mL of urine. Now midstream of the urine is collected in the sterile container.
• 24 Hours of a urine sample
  • In this case, discard the first urine and note the time.
  • Now collect urine in the container for 24 hours and put the last sample in the container.
  • Refrigerate the sample.
  • This 24 hours samples are needed for measuring urea, creatinine, sodium, potassium, glucose, and catecholamines.
• Suprapubic collection of the urine sample:
  This is done in the patients who cannot be catheterized and the sample is needed for culture. This sample is collected by the needle.
• Catheter collection of urine:
  This is done by patients who are bedridden and can not urinate.
• Pediatric urine sample:
  In infants, special collection bags are made adherent around the urethra. Then urine is transferred to a container.

Causes of RBCs in Urine:

There are many possible causes of red blood cells in the urine, also known as hematuria. Some of the most common causes include:

1. Urinary tract infections (UTIs): UTIs are a common cause of hematuria, especially in women. The infection can cause irritation and inflammation in the urinary tract, which can lead to bleeding.
2. Kidney stones or bladder stones: Stones can form in the urinary tract, causing pain and irritation. As these stones pass through the urinary tract, they can cause bleeding.
3. Enlarged prostate in men: An enlarged prostate can press on the bladder and urethra, causing hematuria.
4. Kidney disease or damage: Various types of kidney disease or damage can cause hematuria, including glomerulonephritis, polycystic kidney disease, and kidney infections.
5. Bladder or kidney cancer: Cancer can cause abnormal growths that can bleed and cause hematuria.
6. Inherited disorders, such as sickle cell anemia: Some genetic disorders can cause abnormal red blood cells that can lead to hematuria.
7. Certain medications, such as blood thinners: Some medications can increase the risk of bleeding and hematuria.

There are many other possible causes of hematuria, so it is important to see a healthcare provider for evaluation and diagnosis.

Why Get Tested:

If you experience any symptoms of hematuria, such as blood in the urine, it is important to get tested for various reasons, including:

1. To diagnose underlying medical conditions: Hematuria can be a symptom of a serious underlying medical condition, such as kidney disease or bladder cancer. Testing can help to identify the cause of hematuria and allow for appropriate treatment.
2. To monitor chronic medical conditions: People with chronic kidney disease or other chronic medical conditions may need to be monitored regularly for hematuria.
3. To monitor response to treatment: If hematuria is caused by a specific medical condition, monitoring the amount of blood in the urine can help to assess the effectiveness of treatment.
4. To rule out serious medical conditions: In some cases, hematuria may be a sign of a serious medical condition, such as bladder or kidney cancer. Testing can help to rule out or diagnose these conditions.
5. To ensure overall health: Routine urine tests may include checks for hematuria, which can help to ensure overall health and detect any potential medical issues early on.

When to get tested:

If you experience any of the following symptoms, you should talk to your healthcare provider about getting tested for hematuria:

1. Blood in the urine: If you notice blood in your urine, it is important to talk to your healthcare provider, even if you don’t have any other symptoms.
2. Frequent or painful urination: If you experience frequent or painful urination along with hematuria, it may be a sign of a urinary tract infection or another medical condition.
3. Abdominal or back pain: If you have abdominal or back pain along with hematuria, it may be a sign of a kidney stone or another medical condition.
4. Family history of kidney or bladder disease: If you have a family history of kidney or bladder disease, you may be at a higher risk for hematuria and should discuss testing with your healthcare provider.
5. Recent trauma or injury: If you have recently experienced trauma or injury to the abdomen or urinary tract, it may be a cause of hematuria and should be evaluated by a healthcare provider.
6. Routine screening: Your healthcare provider may recommend routine screening for hematuria as part of your regular checkup or if you have other risk factors for kidney or bladder disease.

Required sample and Preparation:

To test for hematuria, a healthcare provider will typically require a urine sample. The following are some things to keep in mind regarding sample preparation:

1. Clean catch: A “clean catch” urine sample is usually required. This means that you will need to clean your genital area before urinating and then collect the middle portion of your urine stream in a sterile container.
2. Avoid menstrual blood: If you are menstruating, it is best to wait until your period is over to collect a urine sample.
3. Drink water: Drinking plenty of water can help to dilute the urine and make it easier to collect a sample.
4. Avoid certain foods and medications: Some foods and medications can affect the color of your urine and may interfere with the test results. Your healthcare provider may advise you to avoid these for a certain period of time before the test.
5. Follow instructions: Your healthcare provider will provide specific instructions for how to collect and prepare your urine sample. It is important to follow these instructions carefully to ensure accurate results.

Result Interpretation:

The interpretation of hematuria test results will depend on the specific test performed and the individual’s medical history and symptoms. Generally speaking, the following may apply:

1. Microscopic hematuria: If only a small amount of blood is present in the urine and it can only be detected with a microscope, it is referred to as microscopic hematuria. This can be a sign of a variety of conditions and may require further testing to determine the underlying cause.
2. Gross hematuria: If blood is visible in the urine, it is referred to as gross hematuria. This can be a sign of a more serious condition and requires immediate medical attention.
3. Persistent hematuria: If hematuria persists over time or is accompanied by other symptoms, such as abdominal or back pain, it may indicate a more serious underlying condition.
4. False positive results: In some cases, hematuria may be caused by factors other than a medical condition, such as menstruation or certain medications. False positive results can also occur, so it is important to discuss any abnormal results with a healthcare provider.

It is important to note that hematuria testing is just one tool in diagnosing medical conditions. Further testing, such as imaging or a biopsy, may be required to determine the underlying cause of hematuria.

Clinical Finding with Other Tests:

The clinical finding of hematuria may be used in combination with other tests to diagnose underlying medical conditions. Some additional tests that a healthcare provider may order include:

1. Urine culture: This test is used to detect and identify any bacteria or other pathogens in the urine, which can help to diagnose urinary tract infections or other conditions.
2. Blood tests: Blood tests can be used to assess kidney function and detect signs of infection or inflammation in the body.
3. Imaging tests: Imaging tests, such as ultrasound, CT scan, or MRI, may be used to visualize the kidneys and urinary tract and detect any abnormalities or signs of disease.
4. Cystoscopy: A cystoscopy is a procedure in which a small camera is inserted into the urethra and bladder to visualize the urinary tract and detect any abnormalities or signs of disease.
5. Biopsy: In some cases, a biopsy may be required to obtain a tissue sample for further testing and diagnosis.

By combining the clinical finding of hematuria with the results of these other tests, healthcare providers can diagnose and treat underlying medical conditions that may be causing hematuria.

Treatment and Preventions:

The treatment and prevention of hematuria will depend on the underlying cause of the condition. Some potential treatments and prevention strategies include:

1. Antibiotics: If a urinary tract infection is the cause of hematuria, antibiotics may be prescribed to eliminate the infection.
2. Surgery: In cases where an underlying condition, such as kidney stones or a tumor, is causing hematuria, surgery may be required to remove the obstruction or tumor.
3. Medications: In some cases, medications may be prescribed to manage underlying conditions that may be causing hematuria, such as high blood pressure or kidney disease.
4. Lifestyle changes: Making lifestyle changes, such as staying hydrated, avoiding certain foods or medications, and quitting smoking, can help prevent the development of hematuria and other urinary tract issues.
5. Regular checkups: Regular checkups with a healthcare provider can help detect any underlying medical conditions early, before they progress and cause hematuria or other symptoms.

It is important to note that the specific treatment and prevention strategies will depend on the underlying cause of hematuria, and a healthcare provider should be consulted for proper diagnosis and treatment.

FAQs:

What causes red blood cells in urine?

Answer: Red blood cells in urine can be caused by a variety of conditions, including infections, kidney stones, tumors, medications, and inherited disorders.

How is hematuria diagnosed?

Answer: Hematuria is typically diagnosed through a urine test, which measures the number of red blood cells present in the urine.

Is hematuria a serious condition?

Answer: The seriousness of hematuria depends on the underlying cause. In some cases, it may be a benign condition that resolves on its own, while in other cases it may be a sign of a more serious underlying condition.

Can hematuria be prevented?

Answer: Hematuria can sometimes be prevented by staying hydrated, avoiding certain medications and foods, and maintaining good urinary tract health.

What are the symptoms of hematuria?

Answer: Hematuria itself may not cause any symptoms, but the underlying condition causing it may cause symptoms such as pain, fever, or difficulty urinating.

Is hematuria common?

Answer: Hematuria is relatively common and can affect people of all ages and genders.

How is the underlying cause of hematuria determined?

Answer: The underlying cause of hematuria is typically determined through additional tests, such as blood tests, imaging tests, and cystoscopy.

Can hematuria be a sign of cancer?

Answer: Hematuria can be a sign of cancer, particularly in the bladder or kidneys, but it can also be caused by other conditions.

Is hematuria more common in men or women?

Answer: Hematuria affects both men and women, but certain conditions that can cause it, such as urinary tract infections, are more common in women.

Is hematuria always visible to the naked eye?

Answer: Hematuria can be visible to the naked eye (gross hematuria) or only detectable through a microscope (microscopic hematuria).

Can certain medications cause hematuria?

Answer: Yes, certain medications such as blood thinners, antibiotics, and chemotherapy drugs can cause hematuria.

How is hematuria treated?

Answer: Treatment for hematuria depends on the underlying cause and may include antibiotics, surgery, medications, or lifestyle changes.

Does hematuria always require medical attention?

Answer: While hematuria may not always require medical attention, it is important to consult with a healthcare provider if you notice blood in your urine.

Can exercise cause hematuria?

Answer: Intense exercise or physical activity can sometimes cause hematuria, but it usually resolves on its own and does not require medical attention.

Can hematuria be a sign of a sexually transmitted infection?

Answer: Hematuria can be a symptom of some sexually transmitted infections, but it can also be caused by other conditions. A healthcare provider can help determine the cause.

Conclusion:

In conclusion, red blood cells in urine, or hematuria, can be caused by a variety of factors, including infections, kidney stones, tumors, medications, and inherited disorders. Hematuria can be diagnosed through a urine test and may be a sign of a more serious underlying condition, such as cancer. While treatment for hematuria depends on the underlying cause, it is important to consult with a healthcare provider if you notice blood in your urine. Hematuria can sometimes be prevented by maintaining good urinary tract health and avoiding certain medications and foods.

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