What is hematuria?
Hematuria simply means there’s blood in the urine. It comes in two forms, and the difference matters.
Visible (gross) hematuria is blood you can see — it turns urine pink, red, or a brownish, tea-colored shade. Even a tiny amount of blood can be enough to change the color, so seeing it doesn’t necessarily mean you’re losing a lot of blood. Microscopic hematuria is blood you can’t see at all; it’s found only when a urine test detects red blood cells under a microscope, often on a routine check when you feel perfectly fine.
The blood can come from anywhere along the urinary tract: the kidneys, the tubes that carry urine (ureters), the bladder, the prostate, or the urethra. Finding where it’s coming from is the whole point of an evaluation, because that’s what tells you what’s causing it and who’s best to treat it.
What causes blood in the urine?
The causes span a wide range, from minor and self-limited to serious. The most common include:
- Urinary tract infections — a frequent cause, often with burning, urgency, or frequent urination.
- Kidney stones — can scrape the urinary tract and cause bleeding, often with sharp, cramping pain.
- Kidney (glomerular) disease — inflammation of the kidney’s tiny filters, which can let red blood cells leak into the urine.
- An enlarged prostate — a common, benign cause of bleeding in older men.
- Vigorous exercise — long-distance running in particular can cause temporary hematuria.
- Certain medications — including blood thinners, which can make bleeding more likely or more visible.
- Urinary-tract cancers — less common, but an important reason visible blood is never ignored.
That last point deserves emphasis. Most blood in the urine turns out to have a benign cause — but visible blood can sometimes be the first sign of a cancer of the bladder or the rest of the urinary tract, often before any other symptom appears. That possibility, even though it’s the exception, is exactly why every case of visible blood is taken seriously and looked into.
Most blood in the urine has a harmless explanation. But because some causes are serious, the only safe assumption is that it needs to be explained.
A note on color: beets, blackberries, rhubarb, and some medications can tint urine red or pink without any blood being present. A simple urine test settles the question quickly — which is one more reason that red or brown urine is worth checking rather than guessing about.
Should I worry about blood in my urine?
It’s natural to worry, and the honest answer is reassuring in most cases and cautious in all of them: most people who notice blood in their urine have a treatable, non-cancerous cause. But “most” isn’t “all,” and there’s no reliable way to tell the harmless causes from the serious ones just by looking. That’s why the right response is neither panic nor dismissal — it’s to get it evaluated.
A few features raise the level of concern and make prompt evaluation especially important:
- Visible blood rather than microscopic — particularly when it’s painless. Pain tends to point toward an infection or a stone; painless visible bleeding is the kind that most needs a careful look.
- Blood clots in the urine.
- Older age and a history of smoking, which raise the risk that bleeding reflects something in the urinary tract.
- Blood that comes with protein in the urine, swelling, high blood pressure, or a rising creatinine — clues that point toward the kidneys themselves.
If the blood clears up on its own, that’s good — but it doesn’t answer the question of why it happened. Bleeding from the urinary tract often comes and goes, so a single episode that resolves still warrants an explanation.
When should I seek care?
See a doctor without delay for visible blood in the urine — especially if it comes with clots, fever, severe pain, or trouble urinating. Visible blood always warrants evaluation, even when it’s painless, and painless visible blood in particular should never be brushed off.
For microscopic hematuria found on a routine test when you feel fine, it’s usually confirmed on a repeat urine test (a single result can be set off by something temporary, like a recent infection, vigorous exercise, or menstruation) and then evaluated based on your individual risk. It’s still worth following up on — not an emergency, but not something to forget about either.
Noticed blood in your urine, or had it turn up on a test? We can help you figure out the cause.
Request an AppointmentHow is blood in the urine evaluated?
The goal of the workup is to find the source. It usually starts simply and adds steps only as needed:
- Urinalysis — confirms that the red color really is blood, and looks for clues like protein, signs of infection, or abnormally shaped red blood cells and casts that point toward a kidney (glomerular) cause.
- Blood tests — check kidney function (creatinine and eGFR) to see whether the kidneys themselves are involved.
- Imaging — an ultrasound or CT scan to look at the kidneys and urinary tract for stones, blockages, or growths.
- Cystoscopy — a thin scope passed by a urologist to look directly inside the bladder. This is part of a urology evaluation, especially when there’s a concern about the bladder or a cancer risk.
- Kidney biopsy — in selected cases pointing to glomerular disease, a nephrologist may recommend a small kidney biopsy to identify the exact cause.
Which of these you need depends on what the first tests show and on your risk factors, such as age and smoking history. Many of the early tests can be done in our offices, several of which have an on-site lab.
Do I see a nephrologist or a urologist?
Blood in the urine is one of the clearest examples of two specialties working as a team. The split comes down to where the blood is coming from.
| Specialist | Focuses on | Especially when |
|---|---|---|
| Nephrologist kidney doctor | Kidney (glomerular) causes — inflammation of the kidney’s filters and other kidney disease | There’s also protein in the urine, reduced kidney function, high blood pressure, or abnormal red-cell shapes on the urine test |
| Urologist urinary-tract surgeon | The bladder, prostate, stones, and cancer risk in the urinary tract | Blood is visible, there’s a cancer risk to rule out, or imaging suggests a stone or growth — often with a cystoscopy |
In practice the two often work together. A nephrologist evaluates blood that points to the kidneys — particularly when it travels with protein in the urine, changes in kidney function, or high blood pressure, the picture of a glomerular or other kidney disease. A urologist investigates the urinary tract itself and the cancer risk, using tools like cystoscopy that fall within urology. When the cause could lie on either side, the two coordinate so nothing is missed.
You shouldn’t have to diagnose yourself to know which specialist to call. Part of our job is making sure you land in the right place.
At Georgia Nephrology, we evaluate and manage the kidney-related causes of blood in the urine and coordinate with urology when the source is in the urinary tract — so you reach the right care without bouncing between offices on your own. If your hematuria comes with protein in the urine or signs of chronic kidney disease, that’s squarely the kind of case we’re built to handle.
Myths and facts
If the blood went away, I’m in the clear.
Urinary bleeding often comes and goes. Even a single episode that clears up should be explained — the cause hasn’t gone anywhere.
No pain means it’s nothing to worry about.
It’s the opposite: painless visible blood is the kind that most needs evaluation, because it’s less likely to be a simple infection or stone.
It’s probably just dehydration.
Dehydration darkens and concentrates urine but doesn’t usually make it bloody. Pink, red, or brown urine deserves a test, not a guess.
Blood in the urine always means cancer.
Most causes are benign — infections, stones, an enlarged prostate, exercise. Cancer is the exception, but ruling it out is exactly why visible blood is always checked.
