From the Guidelines
If you notice particles in your urine, you should contact your healthcare provider for evaluation as this could indicate several possible conditions, including urinary tract infections (UTIs), kidney stones, dehydration, or contamination from genital secretions, and prompt medical attention is necessary to prevent serious complications. These particles might be crystals, white blood cells, red blood cells, bacteria, or sediment. Common causes of hematuria, which is the presence of blood in the urine, include UTIs, kidney stones, and dehydration, among others 1. For UTIs, treatment typically involves antibiotics such as nitrofurantoin (100mg twice daily for 5-7 days) or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily for 3 days) 1. While waiting for medical attention, increase your fluid intake to 2-3 liters daily to help flush your urinary system. Kidney stones may require pain management with medications like ibuprofen (400-600mg every 6 hours) and medical intervention depending on size. Dehydration can be addressed by increasing fluid intake.
Evaluation and Diagnosis
The evaluation of hematuria should include a thorough history, physical examination, urinalysis, and serologic testing prior to any initial imaging 1. Ultrasound, CT, and MRI are the most common imaging modalities used to evaluate hematuria. The American Urological Association defines microhematuria as three or more red blood cells per high power field on microscopic evaluation of urinary sediment from a properly collected, noncontaminated urinalysis 1. Gross hematuria, on the other hand, is defined as hematuria visible to the physician or patient and has a high association with malignancy, up to 30% to 40%, and therefore all patients with gross hematuria should have a full urologic workup 1.
Risk Factors and Considerations
Patients with risk factors such as 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 should be considered for urology referral for cystoscopy and imaging 1. The presence of proteinuria, dysmorphic RBCs, cellular casts, or renal insufficiency may indicate medical renal disease, which can cause hematuria, and these patients should be referred to a nephrologist 1.
Management and Treatment
The management of hematuria should be based on the underlying cause, and patients with microhematuria and no risk factors or history of recent vigorous exercise, or presence of infection, or viral illness, or present or recent menstruation may not require a complete imaging workup. However, patients with gross hematuria or those with risk factors should undergo a full urologic workup, including cystoscopy and imaging 1. The use of anticoagulant therapy does not alter the urologic evaluation of microhematuria 1. Never ignore persistent or painful urinary symptoms as they could indicate serious conditions requiring prompt medical attention.
From the Research
Possible Causes of Particles in Urine
- Cloudy urine can be a result of precipitated phosphate crystals in alkaline urine, or it can be caused by pyuria 2
- Hematuria, or blood in the urine, can have a range of causes from benign to life-threatening, and can sometimes be accompanied by other particles in the urine 2
- Kidney stones can cause particles in the urine, and are often detected through a combination of imaging and laboratory chemistry, including urine analysis 3
Detection and Diagnosis
- Urine tests, such as dipstick urinalysis, can be used to detect particles in the urine, but may produce false-positive or false-negative results 2
- Ultrasonography can be used to detect kidney stones, but may not be accurate for determining the size of the stones 4
- A 24-hour urine collection may be used to detect particles in the urine, such as hematuria or crystalluria 3
Related Conditions
- Urinary tract infections (UTIs) can cause particles in the urine, and are often diagnosed through a combination of symptoms, risk factors, and diagnostic tests 5
- Urinary retention, or the inability to pass urine, can be caused by a variety of factors, including obstructive, infectious, and neurologic causes 6