Long list of possibilities for microscopic amount of blood in urine of patient

DEAR DR. ROACH

>> My question is about microscopic hematuria. I see a rheumatologist for sarcoidosis. In February 2018, I had various lab tests, including a urinalysis. That test and several since then have shown microscopic hematuria. The rheumatologist sent me to a urologist, who did scans and a scope of the bladder up through the right kidney. There’s a slight stricture of the right ureter. My biopsies were negative.

Tests and scans continue to be OK except for the microscopic hematuria. I am a 60-year-old woman. Is the hematuria a cause for concern? ANSWER >> “Hematuria” means “blood in the urine.” “Gross” hematuria means there is so much blood that it changes the urine color, while “microscopic” hematuria is recognizable only in the laboratory. Blood in the urine can come from anywhere in the urinary system, and there is a long list of possibilities. Although the cause is sometimes never found, your physician should consider urinary tract infection, kidney or bladder stones, and, in the right age group, cancer of the kidney and bladder. CT scans and cystoscopy are commonly performed tests, and the negative result in your case is reassuring.

You have one more reason to have hematuria than others, and that is the sarcoidosis. Sarcoidosis is a condition that can affect any tissue in the body with abnormal clumps of cells called granulomata. (Just one is called a granuloma.) While the lungs are the most common site for sarcoidosis, it can affect the kidney, causing hematuria.

Sarcoidosis also can cause kidney damage, resulting in a high creatinine, so that should be tested. Severe kidney disease from sarcoidosis may be treated with prednisone, but you should see an expert (nephrologist) to consider this diagnosis.

The majority of people with small amounts of blood in the urine with no documented reason for it, including the cystoscopy and scans you had, will not have serious disease. However, it is probably still prudent to keep an eye on the kidneys and bladder periodically.

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