Our body needs to maintain balance within itself while sustaining vital activities. We eat and produce energy for our movements or the functions of our organs, and we either consume or store that energy. In the meantime, we produce lots of waste products during all these metabolic activities.
Furthermore, ions such as sodium, potassium, and calcium need to be kept within specific ranges for our organs to function in a healthy way. These are all carried out by our kidneys which is both one of the ways to remove the waste products in our body and maintain the ion and acid-base balance of the body. Our kidneys perform these functions by producing urine.
The kidneys excrete the substances that need to be removed from the body with urine while protecting the substances that our body needs as much as possible without mixing them into the urine. In other words, our kidneys function as a filter that filters the blood. While doing this, they create a barrier between the blood and the urine and prevent them from mixing with each other. Although all efforts of the kidneys, we lose one to 10 million blood cells through urination in a day. This is a natural process, and these amounts of blood cells do not cause any change in the color of the urine.
Normal fresh urine is pale yellow and clear. The color of the urine may become dark yellow based on the density of waste products present in the urine. Red or cloudy urine mostly means that blood from our kidneys or any part of our urinary tract mixes with the urine. Some medicine and food also turn the urine color into red.
When there is a visible amount of blood in the urine, the situation must be evaluated by a urologist. Blood in the urine (hematuria) may occur as a symptom of many diseases from urinary tract infections to cancers. While investigating the reason for the blood in the urine, the quality of the bleeding gains great importance. Besides the color of the bleeding (bright red, pink, maroon, brown), information such as the existence of accompanying pain or burning, whether there are clots in the urine, whether the bleeding is seen at the beginning or the end of urination helps us diagnose the problem. Also, the age, gender, and job of the patient and whether they smoke are of significance.
For example, bleeding accompanied by burning in a female patient in her 20s brings infection to the mind first while bleeding with clots and no pain in a male in his 60s brings bladder cancer to the mind first. In addition to these, blood in the urine may result from many diseases such as stones in the urinary tract, prostate enlargement, kidney injuries, diseases that may occur in the urine filtering mechanism of the kidneys, or some blood diseases accompanied by blood coagulation disorder. There are, of course, a lot of tests that must be performed to reach the right diagnosis.
The detection of blood (microscopic hematuria) in the urine analyses performed on totally normal-appearing urine is another frequent medical condition and needs to be evaluated by a urologist. At this point, the detection of blood in the repeating analyses is a significant criterion for further evaluation.
It should be noted that blood can be detected in the tests carried out during the menstrual period, after gynecological examination, during periods of high fever, and after sexual intercourse or intense physical activity, and these tests must be repeated.
As a result of the examinations performed in case of the detection of microscopic hematuria, there is a 5-22% likelihood of diagnosing a serious urological disease (stones, tumor, infection). The main purpose of the examination performed on patients diagnosed with blood in the urine is to determine whether this bleeding is the first symptom of a serious disease, especially cancer. Some people are at more risk in terms of developing cancer in the urinary tract than others.
So, a risk assessment must definitely be made. People who are at a higher risk of developing urological cancers can be summarized as: Those with a history of smoking, patients older than 40 years of age, those with a history of radiation therapy to the lower abdomen, those who are under occupational risks (especially exposure to aromatic amines that are chemicals used in the dyeing industry), and those with a history of frequent urinary tract infections.
In case of visible bleeding in the urine or the detection of blood in repeating tests, firstly a urine culture test is made to investigate a possible infection. Kidney functions are examined through blood tests and the existence of blood coagulation disorders is investigated. Also, general ultrasonic testing of the urinary tract must be carried out. Further examinations must be decided based upon the complaints of the patients and the results of the previous examinations.
As the bleeding may result from the upper parts of the urinary tract such as kidneys and ureters or from the low parts of the urinary tract such as the bladder or prostate, these parts of the body should be separately evaluated and screened by taking the risk factors for the patient into consideration.
Medicated kidney x-rays have long been used for the examination of the kidneys and the urinary tract, and they are still used for this purpose.
Thanks to the advances in technology, it is also possible to benefit from medicated or drug-free tomography and have detailed 3D imaging of the urinary tract. Therefore, small stones that could be overlooked with standard x-ray films or the lesions in the urinary tract can be observed.
If the cause of the bleeding cannot be determined with these imaging methods, cystoscopy, the visual examination of the urinary tract and the bladder using a thin camera, may be required. Cystoscopy is a procedure that can be performed under local anesthesia or mild sedative anesthesia and provides us with information that no imaging method can do. With this procedure, it is possible to detect small tumors that cannot be detected with x-ray films. If any suspicious image appears during the cystoscopy procedure, a pathological examination may be performed by taking some tissue.
It should be noted that some bleeding may stem from the structural diseases related to the kidneys, no reason may be determined despite all examinations, and a further evaluation by a nephrologist specialized in structural kidney diseases may be required.
If the cause of bleeding cannot be determined as a result of all these evaluations, it may be necessary to evaluate the situation with urine tests every 3-6 months, and again with imaging methods when necessary by taking the risk factors mentioned above into account.