How is Hematuria Blood in Urine Diagnosed?
Hematuria is diagnosed through urinalysis, which is the testing of a urine test sample for the presence of red blood cells (RBCs) and other abnormalities. The urine sample is collected in a special container in a health care provider’s office or commercial facility and can be lab-tested in the same location or sent to a lab for further analysis.
For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, which is dipped into the urine. Patches on the dipstick change color when RBCs are present in urine. When blood is visible in the urine or a dipstick test of the urine indicates the presence of RBCs, a health care provider examines the urine with a microscope to make an initial diagnosis of hematuria. The next step is to diagnose the underlying cause of the hematuria through additional testing, if necessary.
Urinalysis
Further testing of the urine may be done to check for problems that can cause hematuria, such as infection, kidney disease, and bladder cancer. The presence of white blood cells signals a UTI. Red blood cells that are misshapen or clumped together to form little tubes, called casts, may indicate kidney disease. Large amounts of protein in the urine, called proteinuria, may also indicate kidney disease. The urine can also be tested for the presence of cancer cells.
Blood test
A blood test involves drawing blood at a health care provider’s office or commercial facility and sending the sample to a lab for analysis. A blood test can show the presence of high levels of creatinine, a waste product of normal muscle breakdown, which may indicate kidney disease.
Biopsy
A biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. The biopsy is performed by a health care provider in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography (CT) scan to guide the biopsy needle into the kidney. The kidney tissue is examined in a lab by a pathologist—a doctor who specializes in diagnosing diseases. The test helps diagnose the type of kidney disease-causing hematuria.
Cystoscopy
Cystoscopy is a procedure that uses a tubelike instrument to look inside the urethra and bladder. Cystoscopy is performed by a health care provider in the office, an outpatient facility, or a hospital with local anesthesia. However, in some cases, sedation and regional or general anesthesia are needed. Cystoscopy may be used to look for cancer cells in the bladder, particularly if cancer cells are found with urinalysis.
Kidney imaging tests
An intravenous pyelogram (IVP) is an x-ray of the urinary tract. A special dye, called contrast medium, is injected into a vein in the person’s arm, travels through the body to the kidneys, and makes urine visible on the x-ray. The contrast medium also shows any blockage in the urinary tract.
When a small mass is found with IVP, another imaging test, such as an ultrasound, CT scan, or magnetic resonance imaging (MRI), can be used to further study the mass. Imaging tests are performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging.
Anesthesia is not needed, though light sedation may be used in some cases. Imaging tests may show a tumor, a kidney or bladder stone, an enlarged prostate, or other blockages of the normal flow of urine.
