From the Guidelines
Hematuria with turbid urine is most commonly caused by urinary tract infections (UTIs), which can lead to inflammation and bleeding in the urinary tract, as well as other conditions such as kidney stones, kidney disease, and bladder or kidney cancer. The causes of hematuria can be divided into nephrogenic and urogenic causes, with renal parenchymal disease being the most common benign nephrogenic cause, and common benign urogenic causes including urolithiasis, infection, and benign prostatic hypertrophy 1.
Key Causes of Hematuria
- Urinary tract infections (UTIs)
- Kidney stones
- Kidney disease
- Bladder or kidney cancer
- Prostate problems
- Trauma to the urinary tract
- Certain medications
- Strenuous exercise
Importance of Medical Evaluation
If you experience cloudy, bloody urine, it is essential to seek medical attention promptly, as it could indicate a serious condition requiring treatment. Your doctor will likely perform urinalysis, blood tests, and possibly imaging studies to determine the cause. While waiting for medical care, increasing fluid intake can help flush the urinary system, but self-medication should be avoided as it could mask symptoms important for diagnosis 1.
Risk Factors for Cancer
It is crucial to be aware of risk factors for cancer, such as gross hematuria, male gender, age >35 years, smoking, occupational exposure to chemicals, analgesic abuse, history of urologic disease, irritative voiding symptoms, history of pelvic irradiation, chronic urinary tract infection, exposure to known carcinogenic agents or chemotherapy, and chronic indwelling foreign body, as these can increase the likelihood of underlying cancer 1.
Recommendations for Evaluation
All patients with gross hematuria should have a full urologic workup, given the high association with malignancy, and patients with microhematuria should undergo a thorough history, physical examination, urinalysis, and serologic testing prior to any initial imaging 1. Cystoscopy and imaging should be considered in adults with microscopically confirmed hematuria in the absence of a demonstrable benign cause, and evaluation of hematuria should be pursued even if the patient is receiving antiplatelet or anticoagulant therapy 1.
From the Research
Causes of Hematuria with Turbid Urine
- Hematuria with turbid urine can be caused by several factors, including:
- Urinary tract infections (UTIs) caused by urease-producing gram-negative organisms, which can lead to the formation of infection stones 2, 3, 4
- The presence of infection stones, which can be composed of magnesium ammonium phosphate, carbonate apatite, and monoammonium urate 2, 4
- Urinary tract obstruction, neurogenic bladder, voiding dysfunction, temporary or indwelling urinary catheters, distal renal tubular acidosis, and medullary sponge kidney, which are considered risk factors for developing infection stones 2
- Bacterial, fungal, and viral infections, which can present in different patterns and varying degrees of severity 5
- The relationship between urinary stones and UTIs is complex, with two different clinical pictures: stones that develop following UTIs (infection stones) and stones complicated by UTIs (stones with infection) 2, 3
Risk Factors and Complications
- Patient conditions, urinary tract infection or a history of recurrent infections, characteristics of the stone, and anatomy of the urinary tract are primary predictive risk factors of urosepsis 3
- Infection stones are still a matter of debate, concerning both the aetiology of the disease and its treatment, and can be associated with a higher risk of post-treatment infection and sepsis 3, 4
- The formation of infection stones requires a urease-positive urinary tract infection, which can lead to the development of alkaline urine and the formation of struvite and carbonate apatite crystals 4