Hematuria means red blood cells are present in the urine. It can be visible to the eye (macroscopic) or detectable only by laboratory testing (microscopic). Investigating the cause helps distinguish transient or benign reasons from conditions that need specialist assessment. Below are key aspects of the evaluation, typical causes, initial tests and guidance about urgent symptoms and specialist referrals.
Hematuria is the presence of blood in the urine. Visible color change—bright red or brown— is termed macroscopic hematuria. Small numbers of red blood cells found on urine microscopy are called microscopic hematuria. Episodes that recur or persist require a different diagnostic approach than isolated, short-lived findings; classification helps determine which investigations are appropriate.
Causes range from urinary tract infections and kidney stones to trauma of the urinary tract, benign growths, or cancers in the urinary system. Kidney (glomerular) disorders and systemic bleeding tendencies can also result in hematuria. Non-disease factors—certain medications, vigorous exercise, and vaginal bleeding in people who menstruate—may produce blood in the urine sample.
Evaluation typically begins with a focused medical history and physical exam. Basic tests include dipstick urinalysis, microscopic urine examination and urine culture when infection is suspected. Blood tests such as a complete blood count and kidney function tests may be ordered. Imaging—ultrasound or CT of the urinary tract—and cystoscopy (bladder inspection) are reserved for specific indications based on age, risk factors and initial results.
Seek urgent medical attention if you have heavy, continuous visible bleeding, inability to pass urine or very low urine output, severe flank or abdominal pain, fainting or signs of low blood pressure, or high fever suggesting a serious infection. In such situations, go to an emergency department or contact urgent care services.
Until the cause is established, appropriate follow-up is important. Primary care providers often coordinate initial assessment and may refer to urology or nephrology depending on findings. Smoking and other lifestyle factors can increase the risk of bladder disease; discuss these with your clinician. Decisions about further testing and monitoring are made by specialists based on the pattern of hematuria and test results.
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