Voided pure blood with severe dysuria - Did I pass a kidney stone?

[Beth__0__0]

  I am a 30yold female with a long history of UTIs - approx 2-3 give or take a few per year with typical UTI s/s - dysuria, urinary frequency which quickly resolves with pyridium & antibiotics. My last UTI was in Nov 98 & I felt the typical s/s coming on again last week so I increased my water intake. & felt better. Sat night I had a sudden onset of severe suprapubic pain, severe dysuria, urinary frequency. After about an hour of this - I had bright red blood when I wiped & upon obtaining the UA specimen via clean catch - my urine was completely dark red. I was then catheterized & received the same dark bloody urine, the UA showed only 7-9 WBCs, no bacteria, 3+ protein, moderate ketones. I received 2 liters of IV fluids, IV Kefzol & was sent home on Keflex 500mg QID & pyridium. During this time I had a strong urge to bear down & strain. The next day my groin area was very sore (I guess from the straining) but the pain was gone except for a slight dysuria at the end of voiding. I did have a renal ultrasound done today (Monday) which showed a normal bladder with no masses, but both kidneys were dilated - the right worse than the left with hydronephrosis but no stones were visualized. I had another UA done today also which showed only a trace of blood, everything else normal. Do I need to followup on this or did I pass a kidney stone that requires no further followup. By the way, with my past cases of UTIs - I have had microscopic traces moderate blood but I have never had visible pure bloody urine. I was very frightened. Your response will be appreciated.  

[HFHS M.D.-KR]

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Dear Beth,
Recurrent urinary tract infections are a common problem. The routine evaluation includes a test of the kidneys called an IVP ( an xray to demonstrate blockage and or stones) as well as cystoscopy ( look inside the bladder with a lighted telescope ).  Many young women do not undergo the evaluation because UTI’s in females are so common. These are simply treated as they arise or a prophylactic dose of antibiotics  for three to six months.
The condition you have is called gross hematuria. There are a wide variety of causes ranging from cancers of the bladder and kidney to stones to simple urianry tract. When IVP and cystoscopy do not yield a cause, CT scan is performed.Other less common causes include a condition called papillary necrosis and AV malformations ( a connection between the artery and vein of the kidney). Papillary necrosis leads to bleeding by sloughing off the lining of the kidney. It can result a variety of causes including sickle cell anemia, diabetes and medications such as pain pills ( aspirin, naprosyn, and ibuprofen). AV malformations most commonly occur as result of renal biopsy procedures although they can arise by themselves. These are diagnosed by arteriogram of the kidney.
If no cause is found, Amicar is a reasonable treatment option. It might be helpful to have cystoscopy performed right away when the bleeding occurs so that the side ( right of left kidney ) can be identified. An arteriogram during the bleeding episode may also be helpful. If the cause is not found, the bleeding can come back . This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
HFHS MD-KR
* keyword : gross hematuria