Blood in urine and my frustration!!

[Charyl]

I hope you can give me some insight to relax me!!  I've very incredibly anxious lately over this situation.  I went to the doctors for a totally different reason and he ordered routine tests (blood work, urinalysis).  The results said I had 11-20 rbc in my urine (a trace of bacteria, moderate mucous, and 21-30 amorphous crystals and 0-3 ca ox crystals (whatever that means).  The blood concerned me.  I had to re-do the test as a culture to test for infection.  It showed again 31-50 rbc (trace bacteria and few mucous).  My gyn. put me on Cipro for a week, saying some infections (hemorrhagic cystitis) don't show up on cultures.  I took the antibiotic and repeated the urine a week and a half later.  That urine test again showed 11-20 rbc.  Needless to say, I was freaked out at this point.  My doctor ordered a CT scan of my abdomen and pelvis, with contrast, to show my kidneys, ureters, bladder, etc.)  The CT showed what they called a subcentimeter hypodensity in the upper pole of the left kidney which was too small to characterize.  It also showed a scant amount of free fluid in the right posterior pelvis, which they said is likely physiologic.  The rest of the examination was normal.  I took all of these results to a recommended urologist.  He said that he thinks the hypodensity is a cyst and that kidney cysts are common among people.  He said there is no evidence of anything else.  He did a cystoscopy on me, at my request, and said the lining of the bladder and urethra appeared normal.  He also drew urine directly from my bladder while the scope was in and sent it out for cytology just as a precaution.  His diagnosis of me was idiopathic hematuria.  He said that some people excrete a high number of red blood cells and that the kidney let some get through.  The cytology report said that it "...consisted primarily of vaginal epithelial cells,a nd that there were no identifiable transitional cells present.  The specimen, therefore, is inadequate for evaluating the baldder mucosa."  I was totally confused by this, but my uro. called and said that was a good report - no cancer cells.  I was relieved to hear this, though I still don't quite understand the words in that report.  Finally, I am happy to hear these reports of ruling things out, but I still have no answers.  I am not one to accept idiopathic.  My family doc. just repeated my urine test and it came back still with 21-30 rbc (rare mucous).  All other things have been within normal ranges.  I'm very anxious about this situation because it is still continuing.  My urine is always very dark yellow, though I know I don't drink enough throughout the day.  Sometimes it burns when I urinate if the urine is strong/dark, but usually not.  I'm very frustrated.   What else could this be?  What is being missed?  Could that "cyst" be something else, or can a uro. tell difinitely that its a cyst?  Could my kidneys be sensitive to the cyst and that is why there is blood?  I need answer and peace of mind.

[Kevin Pho, MD]

You have had a pretty good evaluation already, including the CT scan and cystoscopy.  

Regarding the pathology report, it states that it is "inadequate for evaluating the bladder mucosa".  True, that means that there are cancer cells seen, but there is not enough sample to conclusive rule out bladder issue, since the sample was inadequate.  

Given the fact you continue to have RBC's in the urine, repeating the cystoscopy can be considered.  To further evaluate the cyst, an MRI can be done if lesion is not conclusive on the CT scan.  

These options can be considered with your urologist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b