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Answer to your Health Question

Question (04/28/2012):

Title: Hematuria, cystoscopy, pyelogram, tomography and renal biopsy.

I have hematuria for which no cause has been found.

I am 28 years old.

No sickle cell trait has been identified, and a cystoscopy performed by an urologist turned up no disease.

I have had an intravenous pyelogram and both detailed contrast and noncontrast computed tomography of the abdomen and pelvis, all of which were negative for renal or lower urinary system disease.

Is the next step a renal biopsy?



Dear Dan,

Blood in the urine is a common problem. The medical term for red blood cells in the urine is hematuria. Sometimes blood in the urine is a sign of a more serious problem in the urinary tract. Other times it is not serious and requires no treatment.

A trace amount of blood in your urine is normal. The average person with a healthy urinary tract excretes about 1 million red blood cells (RBC) in the urine each day. This amount of blood is not visible. This is not considered hematuria.

An abnormal amount of blood in the urine can be acute (new, occurring suddenly) or chronic (ongoing, long term). Acute hematuria can occur just once, or it can occur many times.

Cystoscopy may miss bladder tumors.

Computed tomography (CT scan) and magnetic resonance imaging (MRI) are imaging methods that create cross-sectional pictures of the internal organs. Both methods rely upon computer analysis.

CT scans or MRIs of the pelvis and bladder are used by physicians to assess large (greater than 5 cm) bulky tumors, lymphatic involvement, and the response of tumors to radiation or chemotherapy.

But neither method can distinguish between surface bladder tumors and those that invade deep muscle tissue. CT scans may be difficult to interpret in patients who have had urethral surgery or radiation therapy.

In addition, CT scans and MRIs cannot diagnose microscopic metastatic disease; for example, they only depict cancerous lymph nodes that are 1 cm or larger in size. However, MRIs, in contrast to CT scans, are able to distinguish blood vessels from lymph nodes.


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