67 years old man presented with hematuria 2 years ago. ultrasound show just few small renal stones. Now presented with gross intermittent (nearly every week) hematuria, no pain and no fever.
Lab data no pus in urine, no stone or mass by ultrasound.
ESR is 10 mm/hr and Hb is 14.7.
What is the possible cause of such a case?
I would like to get a urine cytology to look for any malignant cells. Also, what did the USG done earlier comment on the bladder wall?
Looking at the age and pattern of hematuria, Im more inclined towards a bladder malignancy. Would like to start with urine cytology and follow up with a cystoscopy and imaging, depending on the feasibility.
It would be preferable to do CT scan to get a better view of the lesions in the kidney & bladder . As suggested by Ashwin Singh Parihar , malignancy cannot be ruled out . The significance of stones in the kidneys need to be evaluated .
Other causes of hematuria:
1. Certain primary kidney diseases
2. Vigorous exercise or injury (falling off a bike and bruising a kidney)
3. Enlargement of the prostate (called benign prostatic hyperplasia), common problem in older men
4. Cancer of the bladder
5. Cancer of the prostate
6. Cancer of the kidney, (more often in patients over age 50 years)
7. Sometimes, the urine appears to have blood in it because there are other red substances (pigments) in the urine. This can happen if you eat an excessive amount of beets (called beeturia), food dyes, or certain medications (such as phenazopyridine/Pyridium)
Reference:
https://www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics
Dennis
Dennis Mazur
Malignancy of kidney and bladder needs definitely exclusion by CT scan and cystoscopy.. Another important cause is renal tuberculosis difficult to diagnose. It can present with painless haematuria. Urine culture for tuberculosis or PCR is required for diagnosis. It is not uncommon in my country in India. Schistosomiasis in some country can cause haematuria.. AV malformation in kidney can cause haematuria and can be diagnosed with CT scan and angiography. IgA nephropathy, goodpastur disease and some haematological pathology needs also exclusion.. I agree with all the other causes already mentioned.. Thanks
Many causes of hematuria can be enlisted. However he is harboring renal stone which may be the reason for blood in urine especially in presence of infection. Looking at the age (smoking history not provided) one need to exclude the malignant cause. Urine cytology and cystoscopy are required. Cystoscopy will help in identifying bleeding from prostate, bladder or upper tract. Further imaging (CT Urography) may also be required.
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