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Kidney Diseases

Gross Hematuria - Should I see a Nephrologist

08/16/2010

Question:

Hello - since November, 2009, I have had episodes of blood in my urine. It is not microscopic, but obvious. It has happened randomly over the last 8 months. There is no pain or other symptoms associated with the hematuria. I had a cystoscopy and IVP (with contrast) in November. My urologist said everything was normal. He said if it did go away in a few months to come back for another visit. Since it continued to occur, I recently returned to him. He ordered a CT Scan of my abdomen and pelvis. Everything came back normal. He also checked massaged my prostate and extracted prostate fluid, which also came back normal. Blood tests show no signs of infection, cancer or abnormal cells. I haven`t gotten the results of my PSA test back yet, but from his perspective, he was not anticipating anything abnormal. He spent a lot of time with explaining why most cases of hematuria occur, and that sometimes the cause is never found. He said that they could conduct an angiogram, but it would have to be done while I was having a bleeding episode. He also said that he feels comfortable that anything serious has been ruled out. I asked him if I should see a nephrologist, as my research indicated that there is a possibility that this can be originating from the kidney. He seemed to think that it could be a blood vessel that leaks.

Back in 2003, I had similar episodes and similar tests (except for the CT Scan) and everything came back normal. Back then, the urologist put me on Macrodantin for 6wks and everything cleared up. Until this past November, I had no occurrences since 2003.

I also had one occurrence of hematuria in my 20s, but it was short-lived and went away (I did have a cystoscopy and it was negative).

I`m glad that everything has come back normal, but I still continue to have these episodes of hematuria at random times. I`m not overweight, I don`t smoke, I drink alcohol on semi-rare occasions, and have a relatively normal life.

Should I see a nephrologist for further testing, as it is quite alarming when this happens.

Thanks in advance for your consideration.

Answer:

It is reassuring that you have had thorough urologic examinations which are good at detectiong anatomic abnormalities or cancers and that these are negative(pending the PSA). You did not mention what your kidney function is (which is measured with a routine blood test, creatinine) nor did you mention if there was proteinuria. Since microscopic parenchymal renal disease can also cause hematuria I would suggest at least a one time consult with a nephrologist in order to feel that all possibilities have been investigated. There may be a need for a renal biopsy.

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Response by:

Thomas   Zipp, MD Thomas Zipp, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University