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Q: I am a 37 year old woman. I have been to my doctor because I have had blood in my urine. The doctor put me on antibotics to treat infection, but I am still getting blood. I was tested yesterday, with the results 4++++ and 1+ of sugar. Is this anything to be concerned over? I have had this problem for six weeks.
A: The presence of blood in the urine is referred to as hematuria. As your doctor told you, a urinary tract infection is certainly one of the possible causes of blood in the urine. You mention that the doctor has put you on antibiotics to treat a possible infection, which is certainly a correct way to proceed. I assume your doctor has also done a urine culture, so that he/she has verified the presence of infection and has identified the responsible bacteria. Of course, the antibiotics employed shoud be properly chosen, since not all bacteria respond to all antibiotics. Usually, this is done by determining the sensitivity of the bacteria in the urine to various antibiotics, and then properly selecting the antibiotic employed. Thus, for example, if an inappropriate antibiotic was employed, the bacteria may have not been killed, and another antitibiotic should be instead used.
The presence of blood in the urine requires a careful history and physical examination. Use of certain medicines and associated medical problems may, in general, also provide important clues. Physical examination should, in particular, look for signs of so called systemic diseases, kidney diseases, etc. Laboratory examination should include a urine analysis and urine culture. After treatment with antibiotics, in case of a urinary tract infection, follow-up urine analysis should be performed to make sure that there is no longer any blood in the urine present. If it is believed that the presence of blood is not due to an infection, further evaluation should include urine cytology, imaging of the urinary tract, and cystoscopy. Cytology studies are performed on urine samples to determine whether malignant cells may be present. Imaging studies are performed to identify possible possible kidney malignancies or possible benign conditions that may cause blood in the urine, such as kidney stones and other benign kidney diseases. Cystoscopy is performed by inserying a tube through the urethra to enable the physician to visualize the bladder.
I hope this information is helpful to you. In your particular case, I would suggest asking your doctor whether he/she has identified an infection in your casand performed a urine culture, to determine whether another antibiotic treatment would be more appropriate, if the infection is still present. If he/she does not believe that the presence of blood in the urine in your case is due to infection, a careful work-up should then be performed along the lines outlined above.
Updated: 06/13/99
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