Blood in urine: When to worry and what diagnostic steps to take

Hematuria, or blood in the urine, can have many causes and identifying them requires careful examination. To prevent further complications and to treat the condition promptly, it is essential to identify the cause as soon as possible.
In an interview with HT Lifestyle, Dr Rajat Arora, Lead Consultant – Dept. of Urology at the CK Birla Hospital in Delhi, suggested, “The first step is to review your medical history, which can reveal potential triggers such as recent trauma or infections, or medications (such as blood thinners). A physical examination helps assess any visible signs of injury or underlying health issues. A diagnostic test plays a crucial role in the treatment process.”

He explained, “When it comes to urine analysis, it is used to check for infections, crystals (indicating kidney stones) or abnormal cells, whereas blood tests are used to assess kidney function. Imaging techniques like ultrasound, CT scans, or MRIs help detect structural abnormalities such as tumours, stones, or kidney disease. In certain cases, a cystoscopy is performed to look for abnormalities in the bladder and urethra. In addition to age, gender and smoking history, factors like family history can also give a clue about kidney disease.”
Bringing his expertise to the same, Dr Anup Gulati, Director Urology at Fortis in Faridabad, revealed, “The history taking and physical examination (Digital Rectal Examination) is a must as it gives you an idea about the possible differential diagnosis. It also gives us some idea about the cause of bleeding by the presence of clots and their shape. Also, the amount of blood, timing and duration of bleeding is suggestive of the etiology.”

He elaborated, “First investigation to be done is urine analysis and urine culture. Next in line are the imaging studies like ultrasound, CT scan or MRI. However, ultrasound is the preferred initial investigation. Cystoscopy may be required to rule out lower tract causes of hematuria such as any abnormal bladder growth. URS and RIRS may be required to rule out mucosal abnormalities of the upper tract. In case of any suspicion of malignancy urine cytology may also be indicated. In case of any mass is seen it may require to be biopsied.”
Disclaimer: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.