Condition: Chronic Hematuria
Brief Overview: Chronic hematuria refers to the persistent or recurrent presence of blood in the urine over an extended period. It can be microscopic (not visible to the eye, but detected on urinalysis) or gross (visible to the eye). Chronic hematuria is a sign, not a disease itself, and often indicates an underlying renal, urologic, or systemic condition. Persistent hematuria should always be evaluated.
Etiology: Per UpToDate, there are many causes of hematuria:
- Renal: benign renal mass, malignant renal mass, glomerular bleeding, structural disease, pyelonephritis, hydronephrosis/distention, hypercalciuria/hyperuricosuria, malignant HTN, renal vein thrombus/renal artery aneurysm, arteriovenous malformation, papillary necrosis (sickle cell disease)
- Ureter: malignancy, stone, stricture, fibroepithelial polyp, post-surgical conditions
- Renal and/or upper or lower collecting system: infection, malignancy, urolithiasis, TB, schistosomiasis, trauma, recent instrumentation including lithotripsy, exercise-induced hematuria, bleeding diathesis/anticoagulation
- Bladder: malignancy, radiation, cystitis, bladder stones
- Prostate/urethra: BPH, prostate cancer, prostatic procedures, traumatic catheterization, urethritis, urethral diverticulum
Risk Factors:
- BPH
- Prostate cancer or urinary tract cancers
- Certain medications – anticoagulants/blood thinners, antibiotics, ASA
- Strenuous exercise
- Recent bacterial or viral infections (like strep, hepatitis)
- Glomerulonephritis
- Urinary tract stones
- Age >50 years old
- Tobacco use
- Exposure to certain chemicals/radiation
Commonly Associated Conditions:
- Urinary tract infection (UTI)
- Kidney stones (nephrolithiasis)
- Benign prostatic hyperplasia (BPH)
- Glomerular disease
- Bladder, prostate, or kidney cancer
- Structural urinary tract anomalies
Common Medications: Medications will depend on the underlying etiology. Some possible medications include:
- Antibiotics
- Alpha-blockers
- Analgesics/antispasmodics
- 5-alhpa reductase inhibitors
- Medications for underlying renal disease
Common Labs, Imaging, and Tests:
- Urinalysis, urine culture, urine cytology
- Blood tests
- Imaging: CT, cystoscopy, MRI, ultrasound
- Kidney biopsy
Common Symptoms:
- Visible blood in the urine
- Urinary frequency
- Flank pain, typically unilateral
- Urinary urgency or retention
- Dysuria with or without fever
- Associated symptoms: fever, chills, nausea/vomiting
- Can be asymptomatic
Common Treatments:
- Medications, as above
- Any treatment/procedure indicated for any underlying etiology
- Adequate hydration
Physical Findings:
- May be normal/asymptomatic physical exam
- Flank pain/tenderness
- Suprapubic tenderness or palpable bladder (obstruction).
- Prostate enlargement on digital rectal exam (BPH).
- Edema or hypertension (renal causes).
Potential Complications and Contraindications:
- Urinary tract malignancy (bladder, kidney, or prostate cancer)
- Progressive kidney disease
- Recurrent urinary tract infections
- Urinary obstruction
- Significant bleeding or clot retention (rare but urgent)
- Delayed diagnosis can lead to worse outcomes in malignancy.
General Health and Lifestyle Guidance:
- Hydration: encourage adequate fluid intake to help flush urinary tract. Ask your healthcare provider for specific hydration recommendations.
- Smoking cessation: reduces malignancy risk.
- Chronic disease control: work with your healthcare provider(s) to optimize BP, diabetes, or other comorbidities.
- Advise patients not to ignore visible hematuria or worsening symptoms – make sure to notify healthcare provider(s) promptly.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Suggested Questions to Ask Patients:
- How long have you noticed blood in your urine?
- Is the blood visible or only detected on testing?
- Is it persistent or intermittent?
- Do you have pain with urination or in your sides/back?
- Any history of kidney stones or urinary infections?
- What medications are you currently taking (especially blood thinners)?
- Have you ever smoked or been exposed to workplace chemicals?
- Any family history of kidney or bladder problems?
- Have you had prior imaging or urologic evaluation?
Suggested Talking Points:
- Hematuria can be caused by many things—some are benign, but some require further testing.
- Even if it doesn’t hurt, blood in the urine should never be ignored.
- Staying hydrated, managing risk factors, and keeping up with follow-up testing are key.
- If you ever notice visible blood, clots, or worsening symptoms, call your provider or seek care promptly.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/evaluation-of-hematuria-in-adults?search=chronic%20hematuria&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1573692541
- https://my.clevelandclinic.org/health/diseases/15234-hematuria#diagnosis-and-tests
- https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine#treatment
- https://www.kidney.org/kidney-topics/hematuria-blood-urine-adults