From the Guidelines
Gross hematuria is most commonly caused by urinary tract infections, kidney stones, or bladder/kidney cancers, with a high association with malignancy of up to 30% to 40%. The causes of gross hematuria can arise from anywhere along the urinary tract and are generally divided into nephrogenic and urogenic causes 1. Common benign urogenic causes of hematuria include urolithiasis, infection, and benign prostatic hypertrophy 1. Other potential causes of gross hematuria include:
- Urinary tract infections (UTIs)
- Kidney stones
- Bladder or kidney cancer
- Enlarged prostate
- Trauma to the urinary tract
- Certain medications (e.g., blood thinners)
- Strenuous exercise
- Polycystic kidney disease
- Glomerulonephritis
- Sickle cell disease If you experience gross hematuria, seek medical attention promptly, as it requires a full urologic workup, including a urinalysis, imaging studies (such as CT scan or ultrasound), and possibly a cystoscopy to determine the underlying cause 1. The location and extent of bleeding can provide clues about the underlying cause, with bright red blood often indicating lower urinary tract bleeding, while tea-colored urine may suggest kidney involvement. Upper tract imaging (i.e., CT urogram or renal US) and a cystoscopy are necessary for patients with painless gross hematuria 1. Treatment will depend on the specific diagnosis but may include antibiotics for UTIs, pain management and hydration for kidney stones, or more extensive interventions for cancers or other serious conditions.
From the Research
Causes of Gross Hematuria
The causes of gross hematuria are varied and can be broadly categorized into several groups, including:
- Calculus (kidney stones) 2
- Trauma 2
- Tumors (benign and malignant) 2, 3, 4
- Vascular causes (such as vasculitis) 2, 5
- Miscellaneous causes (including urinary tract infections, glomerulonephritis, and benign prostatic hyperplasia) 2, 6, 4
- Fibroepithelial polyps (a rare and benign tumor) 3
Evaluation and Diagnosis
Gross hematuria can be evaluated using various imaging techniques, including:
- Plain X-rays of the kidney, ureter, and bladder 2
- Ultrasound 2, 3
- Intravenous urography 2
- Computed tomography (CT) scans, including CT urography 2
- Magnetic resonance imaging (MRI) 2
- Retrograde ureterography and pyelography (RGP) 2
- Cystoscopy and ureteroscopy 2, 3, 5
Risk Factors and Associations
Gross hematuria is associated with a higher risk of malignancy, particularly in older adults 6, 4. Certain conditions, such as urinary tract infections and benign prostatic hyperplasia, are more commonly associated with microscopic hematuria, while others, such as tumors and vascular causes, are more likely to cause gross hematuria 2, 6, 4.