Hematuria:

Blood in the Urine

National Kidney and Urologic Diseases Information Clearinghouse

What is hematuria?
U.S. Department
of Health and
Human Services
NATIONAL
INSTITUTES
OF HEALTH

Hematuriaisbloodintheurine.Twotypes
ofbloodintheurineexist.Bloodthatcan
beseenintheurineiscalledgrosshematuria.Bloodthatcannotbeseenintheurine,
exceptwhenexaminedwithamicroscope,is
calledmicroscopichematuria.

What are the symptoms of

hematuria?
Mostpeoplewithmicroscopichematuria
donothavesymptoms.Peoplewithgross
hematuriahaveurinethatispink,red,or
cola-coloredduetothepresenceofred
bloodcells(RBCs).Evenasmallamountof
bloodintheurinecancauseurinetochange
color.Inmostcases,peoplewithgross
hematuriadonothaveothersymptoms.
However,peoplewithgrosshematuriathat
includesbloodclotsintheurinemayhave
pain.

What is the urinary tract?

Theurinarytractisthebodysdrainage
systemforremovingwastesandextrawater.
Theurinarytractincludestwokidneys,two
ureters,abladder,andaurethra.Thekidneysaretwobean-shapedorgans,eachabout
thesizeofafist.Theyarelocatednearthe
middleoftheback,justbelowtheribcage,
oneoneachsideofthespine.Everyday,

Kidneys

Bladder

Ureters

Urethra
Theurinarytract

thetwokidneysprocessabout200quarts
ofbloodtoproduceabout1to2quartsof
urine,composedofwastesandextrawater.
Theurineflowsfromthekidneystothe
bladderthroughtubescalledureters.The
bladderstoresurineuntilreleasingitthrough
urination.Whenthebladderempties,urine
flowsoutofthebodythroughatubecalled
theurethraatthebottomofthebladder.

What causes hematuria?

Hematuriacanbecausedbymenstruation,
vigorousexercise,sexualactivity,viralillness,
trauma,orinfection,suchasaurinarytract
infection(UTI).Moreseriouscausesof
hematuriainclude

Who is at risk for

hematuria?
Almostanyone,includingchildrenandteens,
canhavehematuria.Factorsthatincrease
thechanceapersonwillhavehematuria
include

cancerofthekidneyorbladder

afamilyhistoryofkidneydisease

inflammationofthekidney,urethra,
bladder,orprostateawalnut-shaped
glandinmenthatsurroundstheurethra
attheneckofthebladderandsupplies
fluidthatgoesintosemen

anenlargedprostate,whichtypically
occursinmenage50orolder

polycystickidneydiseaseaninherited
disordercharacterizedbymanygrapelikeclustersoffluid-filledcyststhat
makebothkidneyslargerovertime,takingoveranddestroyingworkingkidney
tissue
bloodclots
bloodclottingdisorders,suchas

hemophilia

sicklecelldiseaseaninheriteddisorderinwhichRBCsformanabnormal
crescentshape,resultinginlessoxygen
deliveredtothebodystissues,clogging
ofsmallbloodvessels,anddisruptionof
healthybloodflow

2 Hematuria:BloodintheUrine

urinarystonedisease
certainmedicationsincludingaspirin
andotherpainrelievers,bloodthinners,
andantibiotics
strenuousexercisesuchaslong-distance
running
arecentbacterialorviralinfection

How is hematuria
diagnosed?
Hematuriaisdiagnosedwithurinalysis,
whichistestingofaurinesample.Theurine
sampleiscollectedinaspecialcontainerin
ahealthcareprovidersofficeorcommercial
facilityandcanbetestedinthesamelocationorsenttoalabforanalysis.Forthetest,
anurseortechnicianplacesastripofchemicallytreatedpaper,calledadipstick,intothe
urine.Patchesonthedipstickchangecolor
whenRBCsarepresentinurine.When
bloodisvisibleintheurineoradipsticktest
oftheurineindicatesthepresenceofRBCs,
ahealthcareproviderexaminestheurine
withamicroscopetomakeaninitialdiagnosisofhematuria.Thenextstepistodiagnosethecauseofthehematuria.

Thehealthcareproviderwilltakeathorough
medicalhistory.Ifthehistorysuggestsa
causethatdoesnotrequiretreatment,the
urineshouldbetestedagainafter48hours
forthepresenceofRBCs.Iftwoofthree
urinesamplesshowtoomanyRBCswhen
viewedwithamicroscope,moreserious
causesshouldbeexplored.Thehealthcare
providermayorderoneormoreofthefollowingtests:
Urinalysis.Furthertestingoftheurine
maybedonetocheckforproblemsthat
cancausehematuria,suchasinfection,
kidneydisease,andcancer.ThepresenceofwhitebloodcellssignalsaUTI.
RBCsthataremisshapenorclumped
togethertoformlittletubes,called
casts,mayindicatekidneydisease.
Largeamountsofproteinintheurine,
calledproteinuria,mayalsoindicate
kidneydisease.Theurinecanalsobe
testedforthepresenceofcancercells.
Blood test.Abloodtestinvolvesdrawingbloodatahealthcareproviders
officeorcommercialfacilityandsendingthesampletoalabforanalysis.A
bloodtestcanshowthepresenceofhigh
levelsofcreatinine,awasteproductof
normalmusclebreakdown,whichmay
indicatekidneydisease.
Biopsy.Abiopsyisaprocedurethat
involvestakingapieceofkidneytissue
forexaminationwithamicroscope.The
biopsyisperformedbyahealthcare
providerinahospitalwithlightsedationandlocalanesthetic.Thehealth
careproviderusesimagingtechniques
suchasultrasoundoracomputerized
tomography(CT)scantoguidethe
biopsyneedleintothekidney.The
kidneytissueisexaminedinalabbya
pathologistadoctorwhospecializes
indiagnosingdiseases.Thetesthelps
diagnosethetypeofkidneydisease
causinghematuria.
3 Hematuria:BloodintheUrine

Cystoscopy.Cystoscopyisaprocedure
thatusesatubelikeinstrumenttolook
insidetheurethraandbladder.Cystoscopyisperformedbyahealthcare
providerintheoffice,anoutpatient
facility,orahospitalwithlocalanesthesia.However,insomecases,sedationandregionalorgeneralanesthesia
areneeded.Cystoscopymaybeused
tolookforcancercellsinthebladder,
particularlyifcancercellsarefound
withurinalysis.Formoreinformationaboutcystoscopy,seetheNational
KidneyandUrologicDiseasesInformationClearinghouse(NKUDIC)fact
sheetCystoscopy and Ureteroscopyat
www.urologic.niddk.nih.gov.
Kidney imaging tests.Intravenous
pyelogram(IVP)isanxrayoftheurinarytract.Aspecialdye,calledcontrast
medium,isinjectedintoaveininthe
personsarm,travelsthroughthebody
tothekidneys,andmakesurinevisibleonthexray.Thecontrastmedium
alsoshowsanyblockageintheurinary
tract.Whenasmallmassisfound
withIVP,anotherimagingtest,suchas
anultrasound,CTscan,ormagnetic
resonanceimaging(MRI),canbeused
tofurtherstudythemass.Imagingtests
areperformedinanoutpatientcenter
orhospitalbyaspeciallytrainedtechnician,andtheimagesareinterpreted
byaradiologistadoctorwhospecializesinmedicalimaging.Anesthesia
isnotneeded,thoughlightsedation
maybeusedinsomecases.Imaging
testsmayshowatumor,akidneyor
bladderstone,anenlargedprostate,
orotherblockageofthenormalflow
ofurine.Formoreinformationabout
imagingtestsusedtoexaminethe
urinarytract,seetheNKUDICfact
sheetImaging of the Urinary Tractat
www.urologic.niddk.nih.gov.

How is hematuria treated?

Hematuriaistreatedbytreatingitsunderlyingcause.Ifnoseriousconditioniscausing
hematuria,notreatmentisneeded.HematuriacausedbyaUTIistreatedwithantibiotics;urinalysisshouldberepeated6weeks
afterantibiotictreatmentendstobesurethe
infectionhasresolved.

Eating, Diet, and Nutrition

Eating,diet,andnutritionhavenotbeen
showntoplayaroleincausingorpreventing
hematuria.

Points to Remember
Hematuriaisbloodintheurine.
Mostpeoplewithmicroscopichematuriadonothavesymptoms.Peoplewith
grosshematuriahaveurinethatispink,
red,orcola-coloredduetothepresence
ofredbloodcells(RBCs).
Hematuriacanbecausedbymenstruation,vigorousexercise,sexualactivity,
viralillness,trauma,orinfection,such
asaurinarytractinfection(UTI).More
seriouscausesofhematuriainclude
cancerofthekidneyorbladder
inflammationofthekidney,urethra,
bladder,orprostate
polycystickidneydisease
bloodclots
bloodclottingdisorders,suchas
hemophilia
sicklecelldisease

4 Hematuria:BloodintheUrine

Whenbloodisvisibleintheurineor
adipsticktestoftheurineindicates
thepresenceofRBCs,theurineis
examinedwithamicroscopetomake
aninitialdiagnosisofhematuria.The
nextstepistodiagnosethecauseofthe
hematuria.
Ifathoroughmedicalhistorysuggestsa
causethatdoesnotrequiretreatment,
theurineshouldbetestedagainafter
48hoursforthepresenceofRBCs.If
twoofthreeurinesamplesshowtoo
manyRBCswhenviewedwithamicroscope,moreseriouscausesshouldbe
explored.
Oneormoreofthefollowingtests
maybeordered:urinalysis,bloodtest,
biopsy,cytoscopy,andkidneyimaging
tests.
Hematuriaistreatedbytreatingits

underlyingcause.

Hope through Research

Inrecentyears,researchershavelearned
agreatdealaboutkidneydisease.The
NationalInstituteofDiabetesandDigestive
andKidneyDiseases(NIDDK)sponsors
severalprogramsaimedatunderstanding
kidneyandurologicproblemsthatcanlead
tohematuria.TheNIDDKsDivisionof
Kidney,Urologic,andHematologicDiseases
supportsbasicresearchintonormalkidney
functionandthediseasesthatimpairnormal
functionatthecellularandmolecularlevels,
includingdiabetes,highbloodpressure,glomerulonephritis,andcystickidneydiseases.
Participantsinclinicaltrialscanplayamore
activeroleintheirownhealthcare,gain
accesstonewresearchtreatmentsbefore
theyarewidelyavailable,andhelpothers
bycontributingtomedicalresearch.For
informationaboutcurrentstudies,visit
www.ClinicalTrials.gov.

For More Information

Acknowledgments

American Kidney Fund

6110ExecutiveBoulevard,Suite1010
Rockville,MD20852
Phone:18006388299,18663002900,
or3018813052
Email:helpline@kidneyfund.org
Internet:www.kidneyfund.org

PublicationsproducedbytheClearinghouse
arecarefullyreviewedbybothNIDDKscientistsandoutsideexperts.Thispublication
wasreviewedbyJeanneCharleston,R.N.,
JohnsHopkinsBloombergSchoolofPublic
Health.

American Urological Association

1000CorporateBoulevard
Linthicum,MD21090
Phone:1866RINGAUA
(18667464282)or4106893700
Fax:4106893800
Email:aua@auanet.org
Internet:www.auanet.org
National Kidney Foundation
30East33rdStreet
NewYork,NY10016
Phone:18006229010or2128892210
Fax:2126899261
Internet:www.kidney.org

5 Hematuria:BloodintheUrine

Youmayalsofindadditionalinformationaboutthis
topicbyvisitingMedlinePlusatwww.medlineplus.gov.
Thispublicationmaycontaininformationabout
medications.Whenprepared,thispublication
includedthemostcurrentinformationavailable.
Forupdatesorforquestionsaboutanymedications,
contacttheU.S.FoodandDrugAdministrationtollfreeat1888INFOFDA(18884636332)orvisit
www.fda.gov.Consultyourhealthcareproviderfor
moreinformation.

National Kidney and

Urologic Diseases
Information Clearinghouse
3InformationWay
Bethesda,MD208923580
Phone:18008915390
TTY:18665691162
Fax:7037384929
Email:nkudic@info.niddk.nih.gov
Internet:www.urologic.niddk.nih.gov
TheNationalKidneyandUrologicDiseases
InformationClearinghouse(NKUDIC)
isaserviceoftheNationalInstituteof
DiabetesandDigestiveandKidneyDiseases
(NIDDK).TheNIDDKispartofthe
NationalInstitutesofHealthoftheU.S.
DepartmentofHealthandHumanServices.
Establishedin1987,theClearinghouse
providesinformationaboutdiseasesofthe
kidneysandurologicsystemtopeoplewith
kidneyandurologicdisordersandtotheir
families,healthcareprofessionals,andthe
public.TheNKUDICanswersinquiries,
developsanddistributespublications,and
workscloselywithprofessionalandpatient
organizationsandGovernmentagencies
tocoordinateresourcesaboutkidneyand
urologicdiseases.

Thispublicationisnotcopyrighted.TheClearinghouse
encouragesusersofthispublicationtoduplicateand
distributeasmanycopiesasdesired.
Thispublicationisavailableat
www.urologic.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES
National Institutes of Health

NIHPublicationNo.124559
March2012
The NIDDK prints on recycled paper with bio-based ink.