Blood in Urine (Hematuria)

Have you noticed blood in your urine?

If this is the case, it might indicate an underlying health problem. It is important to get blood in urine lab tests ASAP. The blood in urine test detects traces of blood in urine caused by urinary tract infection, enlarged prostate, kidney stones, and vigorous exercise such as long-distance running

If you've noticed blood in your urine, it could be a sign of something serious. It may indicate an infection or other medical condition. The good news is that the problem can often be treated with antibiotics. However, some conditions may lead to more serious problems like kidney failure and even death if left untreated. Don't wait until it's too late – get tested today!

If you want to learn more about blood in the urine and the lab tests that can help you, click on the title of the articles below.

Blood in your urine doesn't always mean something's wrong, but when there is, don't ignore it. The first step is to get tested for the cause of the bleeding and find out what's causing it. We can help with that! Our quick, accurate lab tests will give you peace of mind by letting you know if there is any reason for concern.

We have lab tests for identifying traces of blood in urine caused by urinary tract infection, enlarged prostate, kidney stones, strenuous activity such as running, and other causes of blood in the urine. This allows you to receive treatment sooner rather than later when your symptoms are less severe but still harmful. Don't let a minor problem evolve into a major one; take care of yourself today with our quick lab tests.

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Comprehensive Metabolic Panel


Diabetic nephropathy is a complication of diabetes and is characterized by proteinuria. Before overt proteinuria develops, albumin excretion increases in those diabetic patients who are destined to develop diabetic nephropathy. There is a need to identify small, but abnormal, increases in the excretion of urinary albumin (in the range of 30-300 mg/day, ie, microalbuminuria). The National Kidney Foundation guidelines for the management of patients with diabetes and microalbuminuria recommend that all type 1 diabetic patients older than 12 years and all type 2 diabetic patients younger than 70 years have their urine tested for microalbuminuria yearly when they are under stable glucose control.

A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Culture, Urine, Routine 

Test Details

IMPORTANT- this is a REFLEX test..... ADDITIONAL CHARGES WILL BE APPLIED IF TEST IS POSITIVE.

If culture is positive, CPT code(s): 87088 (each isolate) will be added with an additional charge.  Identification will be performed at an additional charge (CPT code(s): 87077 or 87140 or 87143 or 87147 or 87149).

Antibiotic susceptibilities are only performed when appropriate (CPT code(s): 87181 or 87184 or 87185 or 87186).

  • ORG ID 1. $ 12.45 
  • ORG ID 2. $ 23.95 
  • PRESUMPTIVE ID 1. $ 12.45 
  • PRESUMPTIVE ID 2. $ 23.95 
  • SUSC-1  $14.95 
  • SUSC-2  $28.95
     

Clinical Significance

Culture, Urine, Routine - This culture is designed to quantitate the growth of significant bacteria when collected by the Clean Catch Guidelines or from indwelling catheters.  Quantitative culturing of urine is an established tool to differentiate significant bacteruria from contamination introduced during voiding. This test has a reference range of less than 1,000 bacteria per mL. More than 95% of Urinary Tract Infections (UTI) are attributed to a single organism. Infecting organisms are usually present at greater that 100,000 per mL, but a lower density may be clinically important. In cases of UTI where more than one organism is present, the predominant organism is usually significant and others are probably urethral or collection contaminants. When multiple organisms are isolated from patients with indwelling catheters, UTI is doubtful and colonization likely.


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To screen for and monitor kidney dysfunction in those with known or suspected kidney disease. Cystatin C is a relatively small protein that is produced throughout the body by all cells that contain a nucleus and is found in a variety of body fluids, including the blood. It is produced, filtered from the blood by the kidneys, and broken down at a constant rate. This test measures the amount of cystatin C in blood to help evaluate kidney function.Cystatin C is filtered out of the blood by the glomeruli, clusters of tiny blood vessels in the kidneys that allow water, dissolved substances, and wastes to pass through their walls while retaining blood cells and larger proteins. What passes through the walls of the glomeruli forms a filtrate fluid. From this fluid, the kidneys reabsorb cystatin C, glucose, and other substances. The remaining fluid and wastes are carried to the bladder and excreted as urine. The reabsorbed cystatin C is then broken down and is not returned to the blood.


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Creatinine Clearance is used to evaluate the glomerular filtration rate (GFR). Clearance is defined as that volume of plasma from which a measured amount of substance could be completely eliminated into the urine per unit of time. Daily creatinine production is fairly constant except when there is massive injury to muscle

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Dipstick urinalysis is important in accessing the chemical constituents in the urine and the relationship to various disease states. Microscopic examination helps to detect the presence of cells and other formed elements.

NOTE: Only measurable biomarkers will be reported.



Blood in Urine (Hematuria) and Lab Testing

Hematuria is a medical term used for describing the presence of blood in the urine. It is not normal, but it’s not as uncommon as some might think. An individual who experiences blood in the urine might be worried, but it isn’t always a cause for alarm. It’s a symptom of something and not a disease. A healthcare practitioner will take it as a sign to further investigate to try and find the root cause of the problem. 

The presence of blood in urine isn’t always apparent. Sometimes, the amount of blood is so tiny that it is only detected during an analysis performed as part of the overall health checkup. Typically, urine is transparent, and a shade of yellow that ranges from pale straw to light amber. The shade of yellow depends on urine concentration. If blood is present in the urine, the urine color will be different, but it’s not always red. 

Gross hematuria refers to visible blood levels in the urine, and this type of urine is likely to be red tea or pink colored. In cases where blood clots are present in the urine, a person might see the clots or drops of blood in the toilet while they are urinating. Microscopic hematuria refers to the type where blood can’t be seen with the naked eye, and this type of hematuria doesn’t affect the urine color. 

As far as the causes of hematuria are concerned, it typically involves issues with the urinary tract. The urinary tract consists of a bladder, a urethra, two ureters, and two kidneys. 

Kidneys continuously produce urine by filtering out the waste from the blood. Kidneys push the urine into the bladder through ureters, and the bladder stores the urine before it is pushed out of the body through the urethra during urination. Blood in the urine can also be caused by conditions involving other bodily systems. Keep on reading to know more about the causes of this condition. 

Causes 

Hematuria can have many causes. Some of these are temporary, benign states that don’t require any specific treatment and resolve on their own. However, it might also be a symptom of a more critical or chronic condition that needs immediate medical intervention and monitoring. 

Further investigation is the only appropriate measure to fully understand the severity or seriousness of hematuria in an individual. The healthcare practitioner will evaluate the individual’s medical history during the investigation, along with their physical examination and associated signs and symptoms to determine the underlying cause of hematuria. 

Some of the common questions that might be asked as part of the examination include: 

Is that blood in the urine? 

Usually, the first question asked in the physical examination is whether blood is visible in the urine. 

There can be many sources of that reddish-looking clot in the urine. Many foods such as rhubarb or beets can give that reddish-brown coloring to the urine. Certain drugs such as phenothiazine, phenazopyridine (most commonly), diphenylhydantoin, cascara, phenacetin, methyldopa, phenolphthalein, and phenindione can also cause red-colored urine. 

Another cause could be the presence of hemoglobin in the urine. Sometimes, red blood cells in the body are broken apart, which leads to the release of hemoglobin. As you are aware, hemoglobin is the iron-containing protein responsible for the red color of the red blood cells. This excess hemoglobin gets eliminated through the urine, making the urine red or tea-colored. Hemolytic anemia also includes sickle-cell anemia, which can also cause hemoglobinuria. 

Urine color can also be changed when the body eliminates certain other substances through urine. For instance, the liver typically removes bilirubin. Still, if the liver is diseased or damaged, it can accumulate bilirubin, and it might make the urine dark amber in color. This is something that should be investigated, but it’s not hematuria. Myoglobin is a small oxygen-binding protein that is typically found in the heart as well as skeletal muscles. It is also eliminated through urine when kidneys filter the blood. If high levels of myoglobin are present in the urine, it might cause the urine to turn red, which might be misinterpreted as blood in the urine. 

Source of Blood in the Urine 

Contaminated blood can become part of the urine through various sources such as hemorrhoids and vaginal bleeding (menstruation). 

Can Infection Cause Hematuria? 

Sometimes, infections can lead to smelly and cloudy urine and painful urination. It might also, sometimes, lead to blood in the urine. 

  • Urinary Tract Infections: These are infections typically caused by bacteria and primarily affect the bladder. These might lead to bladder inflammation (cystitis). 
  • Infection in Kidney: When an infection in the urinary tract spreads to the kidneys. 
  • Viral Infection: In some instances, infections such as hepatitis, which leads to liver inflammation and liver disease, might cause blood in the urine. 

Blood in the Urine – Known Cause or Single Isolated Incident 

At times, blood might appear in the urine and disappear without identifying the underlying cause. At other times, the presence of blood in the urine might be due to a self-limited, resolvable, or identifiable cause such as fever, strenuous exercise, or exposure to certain toxins such as dyes in radiologic procedures. 

Certain medications such as aspirin, Non-steroidal anti-inflammatory drugs, or blood thinners that prevent clotting might also cause the presence of blood in the urine. Another temporary cause of blood in the urine could be a medical procedure involving some part of the urinary tract, such as a kidney biopsy, surgery, or insertion of a urinary catheter. A physical injury to the bladder or kidney might also lead to a temporary presence of blood in the urine. 

Hematuria Causes – Irritation or Inflammation of the Urinary Tract or Prostate in Men or Passage of or Blockage by a Kidney Stone. 

Here are some of the reasons that might lead to blood in the urine accompanied by painful urination, radiating pain, urinary hesitancy, and/or urinary urgency: 

  • Urethritis: It refers to inflammation of the urethra, which is a duct responsible for carrying urine collected in the bladder out of the body 
  • Prostatitis: It refers to prostate inflammation. The prostate is the organ surrounding the urethra in men 
  • Bladder or kidney stones 
  • Benign Prostate Hyperplasia 
  • Hematuria Causes: Condition Causing Kidney Damage or Some Kidney Disease 

Many kidney diseases can lead to hematuria. For example, glomerulonephritis is a kidney disease associated with filtering units in the kidneys known as glomeruli. Another cause could be kidney disease that happens after strep throat, and it is known as post-infectious glomerulonephritis, and it can lead to the presence of blood in a child’s urine.  

Hypertension or high blood pressure and diabetes are also known to cause kidney damage, and these can also sometimes lead to hematuria. Polycystic kidney disease might cause the formation of cysts in the kidneys, which can cause kidney disease. It is an inherited disorder. 

Hematuria Causes – Diseases or Conditions Involving the Urinary Tract. 

If the urinary tract has some structural abnormalities, these can lead to bleeding. Sometimes, blood clots form in the urinary tract, and that can cause blood in the urine. 

A condition known as endometriosis can also lead to hematuria. It is a condition where a tissue that typically lines the uterus starts to grow in other places such as the bladder. 

Hematuria Causes – Inherited and/or Chronic Disorder 

Hematuria could also be caused by an underlying disorder affecting the whole body (systemic) that causes excess blood in the urinary tract. Some of these conditions include: 

Bleeding Disorders – Bruising, bloody, or prolonged bleeding are some common disorders causing excessive bleeding throughout the body. Some of the common examples of these disorders include hemophilia and thrombocytopenia. 

Alport Syndrome – It’s an inherited disorder that causes blood and protein in the urine. 

Autoimmune Diseases – It’s a group of disorders where the immune system in the body starts attacking the body itself, which causes damage to various organs and tissue in the body, including the kidneys. 

Hematuria Causes – Cancer. 

Cancers associated with the prostate and urinary tract can also lead to hematuria. Common examples include prostate cancer, kidney cancer, and bladder cancer. 

Symptoms and Signs of Hematuria 

Many people with hematuria won’t show any signs or symptoms. However, people typically display symptoms associated with another underlying condition. Some of the common examples of signs and symptoms include back pain, abdominal pain, urgent and/or frequent urination, painful urination, fever with infections, severe pain due to kidney stones, swelling of the ankles, legs, or feet (edema) as well as urinary hesitancy which means difficulty in urination or flow interruption. 

Laboratory Testing 

Tests are performed to identify and address the root cause of the problem and to determine the severity, extent, and persistence of blood in the urine. Typically, a health practitioner will perform an initial set of tests to determine the prevalence of hematuria and to rule out and identify some of the common causes. The findings of these initial tests, combined with the medical history and signs and symptoms shown by the affected individual, will determine the need for a more extensive workup. 

Initial Testing 

  • Urinalysis – It is the primary test through which the presence of hematuria is confirmed. It involves chemical and visual examinations to identify gross hematuria through visual examination of the urine color and a chemical test strip. In case of any abnormal findings, a further microscopic examination is done. Multiple samples of urine might be tested. 

As per the American Urological Association, microscopic hematuria is confirmed when three or more red blood cells are present in the high-powered microscope field in two of the three urine samples. Results from the urinalysis (presence of protein) might also help determine the underlying cause. 

  • Urea Nitrogen and Creatinine – These blood tests are performed to evaluate kidney function. These tests might form part of the comprehensive metabolic panel or basic metabolic panel. 
  • CBC or Complete Blood Count – This test checks the number of platelets and blood cells. The health practitioner might ask for this test for a general health evaluation or when they suspect a blood cell abnormality, infection, or anemia. 

Follow-Up Testing – Kidney Health and Kidney Function 

  • Urine Culture – This test is done to determine the presence of bacterial infection. 
  • Cystatin C – This test might be performed as an alternative to the blood creatinine test and for calculation of estimated glomerular filtration rate (eGFR). 

Urine cytology – This test is performed for the identification and presence of any abnormal cells in the urine sample. 

The health practitioner might order further tests based on the initial test results along with your medical history, physical examination as well as other signs and symptoms. These tests are only done when indicated to help investigate the root cause of the presence of blood in your urine. Some examples of these non-routine tests include: 

Analysis of Kidney Stone: It is performed to check the kidney stone composition passed into the urine. The stone itself is tested. 

  • Sickle Cell Tests – This test is performed to check whether sickle cell disease is the root cause of hemoglobin in urine. 
  • Hemoglobinopathy Evaluation – These tests are performed for identifying various inherited disorders that affect red blood cells. 
  • Autoantibody Testing – This test is performed for the identification of autoimmune disorders. 
  • Kidney Biopsy: This test is sometimes used for evaluating the nature and extent of structural damage to the kidney. 

Benefits of Blood in Urine Tests (Hematuria) Lab Testing with Ulta Lab Tests

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