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Monday, September 1, 2014
Trace hematuria in 26yo male. Followup?
Recently, I suffered my first attack of atrial fibrillation with an unknown cause. Upon arrival at the ER, I gave a urine sample. I gave another sample the following day. Both results show trace amounts of hematuria. My cardiologist is suggesting I follow up with a nephrologist. Is it appropriate to follow up with a nephrologist or a urologist for the hematuria? I did have a CT scan with and without contrast which results were normal. Do you know any causes that are likely for me at my age. I am non-smoker and in general good health. Thank you very much for your help.
At this point, it's most appropriate for you to see a nephrologist (non-surgeon).
The initial questions that need to be answered are:
- Is your kidney function (as measured by the blood tests BUN and creatinine) normal?
- Is there any sign of kidney damage, such as high blood pressure or protein in the urine?
- Is there any sign of infection or inflammation in the bladder, prostate, or urethra?
- Do you have any other diseases such as lupus or a disorder of blood clotting?
- Is there any structural abnormality of the kidney or urinary tract (ureters, bladder, prostate, urethra)?
Because you apparently have no symptoms and because your contrast-CT was normal, the answers to all of the above questions are most likely going to be "no." The nephrologist will probably order an ultrasound, which may be a little better at detecting structural abnormalities of the kidney than a CT is. Then if the workup remains negative, you can either be followed for several months/years to see if the hematuria gets worse or better; or you can see a urologist, who will probably perform a cystoscopy to see if there is anything abnormal in the bladder. If not, you can continue to be followed once or twice a year by either a primary doc or nephrologist to see if anything develops.
A common type of kidney disorder that causes microscopic hematuria is IgA (immunoglobulin A) nephropathy. This is more common in certain ethnic groups, including people from western Europe (Netherlands, Belgium, France), southeast Asia, and Navajo Indians, and very rare in blacks. In this disease, hematuria is often the first and sometimes only manifestation, and blood in the urine may actually be visible if the person has a respiratory or GI infection. So this is a disorder that may be considered if you are in one of the ethnic groups above. However, the most likely cause of the hematuria at your age is "idiopathic," or unknown; and once you undergo the tests above, they should not need to be repeated unless something changes. Hope this info helps, and please write again if you have more questions.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University