Your health care professional will want a sample of your urine to confirm that you have hematuria. In women, blood can get into the urine during menstruation. Your doctor may want to repeat the urine test between periods.
Once your doctor has confirmed that you have hematuria, he or she will ask about your medical history and your family's medical history, especially any history of kidney disease, bladder problems or bleeding disorders. Your doctor also will ask about any recent trauma or strenuous exercise, recent viral or bacterial infections, the medications you take, and your symptoms, including more frequent urination, pain with urination and pain in your side.
Your doctor also will examine you. He or she will take your temperature and blood pressure, and will see if you have pain or discomfort in your side or over your bladder. The doctor may recommend that women undergo a pelvic examination, and men undergo a prostate examination.
Your doctor will ask you for a fresh urine sample for a urinalysis. Urine is analyzed in the laboratory to look for protein, white cells and red cells to identify a kidney or bladder infection, or kidney inflammation (glomerulonephritis).
Then, depending on the suspected cause of your hematuria, additional testing may include:
Urine culture — In this test, a sample of urine is monitored to see if bacteria grow. This test is used to confirm a kidney or bladder infection.
CT scan of the kidneys, ureters and bladder— Most often the computerized tomographic (CT) scan is done without intravenous contrast first. If additional information is still needed, the radiologist may want to inject a dye (also called a contrast medium) into an arm vein. The dye collects in the kidneys and is excreted in the urine, providing an outline of the entire urinary system. Tell the radiologist about your allergies, especially any previous reaction to contrast medium.
Ultrasound — This test uses sound waves to help establish whether a kidney mass is a noncancerous (benign), fluid-filled cyst or a solid mass, such as a cancerous tumor. Ultrasound also can identify kidney stones.
Cystoscopy — In this test, the doctor inserts a flexible telescope into the urethra and passes it into the bladder to inspect the bladder lining for tumors or other problems. This test usually is done with local anesthesia and sedation.
Blood tests — These can check for signs of urinary tract infection, kidney failure, anemia (which often accompanies kidney problems), bleeding disorders, or abnormally high levels of blood chemicals that can encourage the formation of kidney stones.
Additional testing for conditions causing kidney inflammation (such as lupus) may be recommended, depending on the findings of the routine blood and urine tests.