Blood in Urine: What Doctor Should I Call?

Blood in urine can be sourced to cancerous growths, infections in the urinary and genital system, or kidney stones among other diseases. The level of medical care and specialist intervention is determined by the symptoms that you show. Although it is a sign and not a disease, it should not be neglected. Immediate medical attention is needed, as the source can be from anywhere in the urinary tract to being a benign tumor in the kidneys. It is also known as hematuria due to the presence of RBC (red blood cells containing hemoglobin) in the urine. Visible blood in the urine is known as macroscopic hematuria, and microscopic hematuria is the presence of blood in microscopic traces.

The red/pink color of the blood can also be caused by myoglobin, hemoglobin, porphyrins, consumption of beets (betanin), and even drugs like sulphonamides and rifamcin. 

The common and rare causes of this condition include:

• Trauma
• Intense workouts or exercise
• Polycystic Kidney Disease
• Urinary Tract Infections due to Escherichia Coli and other bacteria
• Cancerous growths in the bladder, kidneys, or prostate
• Fibrinoid Necrosis, Paroxysmal Nocturnal Hemoglobinuria, Athletic hemtauria, allergies (in children), and other rare causes
• Prostatitis, Sickle Cell anemia, previous urinary tract surgery, Menstruation, and Schistosomiasis (snail fever) are some of the symptoms found less commonly as the cause

Family Physician – The primary caregiver

The primary caregiver goes through your medical history, performs a physical examination, and analyzes the symptoms. He verifies the presence of blood through lab tests, the dipstick test being the most common test. Even after a dipstick test, a microscopic routine is necessary to rule out any false positives. Sometimes even further diagnosis by CT scan, ultrasound, and an overnight urine observation is done to better understand the cause.

The basic health parameters are strong, but still you are showing symptoms of infection and inflammation of the urogenital system. In such a situation, the family physician prescribes a short course of antibiotics. If the inflammation, pain, and discomfort clear up, you resume normal activity. If the symptoms persist, then you need a better diagnosis and preferably another doctor.

Specialized care: Urology Medicine, Urinary Surgery, and Nephrology

If primary care doesn’t resolve medical issues, you will be referred to a specialist. Depending on the seriousness of the condition, the following specialist doctors may be recommended.

• Urologist (urinary specialist associated with urology medicine)
• Urinary Surgeon (urologist who specializes in surgical intervention)
• Nephrologist (the specialist handling kidney disorders) 

Antibiotics relieve the symptoms, but pain recurs, and the passage of blood in urine spikes in intensity. If these symptoms persist beyond a reasonable duration (one or two weeks), you need the services of the urologist.

The urologist may prescribe more advanced screening methods to rule out serious ailments like cancer. These may include the following.

• Cytoscopy - cytological evaluation of urine cultures
• Ureteroscopy – for a complete checkup of the upper tracts in case of any tumor
• Complete blood count (CBC) - a more comprehensive blood test to rule out anemia, leukemia, and other major disorders

Physical examination of the abdomen and groin by the urologist (urology medicine) might reveal a bump or an enlarged kidney that could indicate a polycystic condition or cancerous tumor in the kidney. The following screening tests may be recommended.

• The urinary bladder and urethra will be checked visually (with a cystoscope) for malignant growths or obstructions impeding the urine flow.
• The CT scan helps locate and identify growing tumors in the urogenital system.
• The noninvasive abdominal ultrasound ensures that the kidney doesn’t harbor a growing stone.

For a proper diagnosis, the medical history of the patient is elemental, along with the details of any such disorders in the family. If stones are detected in the kidney, ureter, or lower down in the urinary bladder, the urinary surgeon (urology surgery) removes the offending stone through an endoscopic procedure. The urinary surgeon deals with a host of complications, like kidney and bladder cancer and prostate enlargement, which can trigger the presence of blood in urine.

The Kidney Specialist

The nephrologist is a specialist dealing exclusively with the diseases and disorders that afflict the kidney. He evaluates the following conditions that may cause blood to appear in the urine, and then he suggests medication and possibly surgery.

• Acute kidney disease and kidney failure following prolonged infection and kidney inflammation
• Polycystic conditions that enlarge the kidney and destroy healthy cells
• Cancer of the kidney evidenced by uncontrolled tumorous growths
• Kidney stones that cause excessive bleeding and pain

The nephrologist will call for screening tests, like the Kidney Function Test, and measure hypertension to assess the health of the kidney. He will have a say in deciding the medicines and will recommend surgery where it is feasible. Though he cannot perform surgery, he will try to put forward the best possible treatment option and recommend you to a specialist, if needed.

Medical and Surgical Oncology: the Cancer Specialist

Cancer can strike anywhere in the urinary or reproductive system, most commonly in the kidneys, urinary bladder, and the prostate, resulting in blood in urine. Only after a differential diagnosis and biopsy may the doctor reach a decision. The specialist in oncology medicine will then suggest a combination of chemotherapy and radiation to control and destroy tumorous growths. The oncology surgeon intervenes only when surgery is the preferred option to quickly remove tumors before cancer spreads to other tissues and organs. Surgery is also dependent upon the stage of the cancerous growth. When medications and therapies are not enough to treat the cancer, surgery will be recommended.

Prevention

Though it is not possible to predict or prevent a condition like hematuria, some steps can be taken to be on the safer side. Eating foods with less or no oxalate content, drinking an optimum amount of water every day, restricting salt in the diet, maintaining genital hygiene, and avoiding any harsh genital products could go a long way in preventing any such disorder associated with hematuria. Periodic doctor checkups should be continued if an existing condition has stopped.

Therefore, if there is blood in your urine, it is crucial to go to a doctor to get proper advice.