Managing Hematuria in Older Adults

What Is Hematuria in Older Adults?

Hematuria is defined as the abnormal presence of blood in the urine. It can occur at any age. Hematuria is common in older adults due to kidney-related or other diseases. It can be associated with symptoms like painful urination, nausea, vomiting, fever, abdominal pain, etc. In some cases, hematuria may be caused due to a mild condition while in other cases it may be due to a serious underlying condition. Hence, it is essential to get consulted even if a tinge of blood appears in the urine. Individuals with inherited diseases, family history, and urological or kidney-related issues are at higher risk for hematuria.

What Are the Types of Hematuria?

There are two types of hematuria;

• Gross Hematuria: When there is enough blood in the urine that is visible with the naked eye, then it is called gross or visible hematuria. The urine appears red, pink, brownish-red, or tea-colored in gross hematuria.

• Microscopic Hematuria: In this type of hematuria, the urine appears with normal color but there will be more red blood cells that will be visible only under the microscope. Microscopic hematuria is commonly diagnosed with a dipstick.

What Are the Causes of Hematuria in Older Adults?

Hematuria or blood in urine can occur in older adults due to numerous causes such as;

• Benign Prostatic Hyperplasia (Enlarged Prostate): Enlarged prostate is one of the most common causes of hematuria in older adults above the age of 50 years.

• Urinary Tract Infections (UTI): UTIs can occur in any part of the urinary tract. Women are more likely to develop than men. It is characterized by symptoms like painful and frequent urination with bloody or cloudy urine.

• Urinary Stone Diseases: Kidney stones, bladder stones, ureteral stones, etc.

• Malignancies of the Urinary Tract: Cancer in any part of the urinary tract such as the bladder, kidney, or prostate presents commonly blood in urine as the symptom.

• Pyelonephritis: It is a type of urinary tract infection that causes inflammation of the kidney. Pyelonephritis can be due to bacterial or viral infection.

• Mineral Imbalances: Individuals with high calcium levels usually experience blood in the urine. It can be associated with a burning sensation during urination.

• Glomerulonephritis: Inflammation of glomeruli or tiny filters in the kidney can cause pink or rust-colored urine.

• Drug-Induced Hematuria: Blood in the urine can occur as a side-effect of certain medications like warfarin, heparin, rifampin, cyclophosphamide, non-steroidal anti-inflammatory drugs (NSAIDs), etc.

• Intense Physical Activity: It commonly appears as microscopic hematuria and may last for 3 days.

• Inherited Diseases: Hemophilia, sickle cell anemia, Alport syndrome, inherited nephritis, etc. can cause blood in the urine.

• Idiopathic Hematuria: Hematuria may appear in some individuals without any underlying condition and that is known as idiopathic hematuria. As it runs in families, individuals with idiopathic hematuria usually inherit it from their parents.

How Is Hematuria Diagnosed?

The physician will take a detailed history of symptoms experienced by the individual which includes;

• Change in color of urine

• Frequency of urination

• Pain or burning sensation while urinating

• Abdominal pain

• Overuse of any medications or drugs

• Symptoms like fever or chills

• Nausea or vomiting

• Family history of kidney diseases or hematuria

After history taking, patients will be advised to undergo the following investigations;

• Urine Tests: Urinalysis is a common urine test to detect the cause of hematuria. Urine culture and urine cytology are also done in some cases to get a detailed picture of the underlying cause.

• Blood Test: Blood tests are conducted to check for the levels of serum creatinine, calcium, and urea. In addition, bleeding time, clotting time, and full blood count are also tested. Prostate-specific antigen tests are done in males to inspect for prostate cancer.

• Cystoscopy: It is a type of endoscopy where a thin camera is used to examine the inside of the bladder. In cystoscopy, a thin tube with a light and a camera are inserted into the urethra by the physician. Usually, it's a painless procedure.

• Kidney Biopsy: It is a medical procedure where a tiny piece of the kidney is removed to do a microscopic examination. Hematuria and proteinuria (protein in urine) are the common indications for kidney biopsy.

• Imaging Tests: Following imaging tests are performed to examine kidneys, ureters, and bladder.

1. Ultrasound

2. Computed tomography (CT)

3. Magnetic resonance imaging (MRI)

4. Intravenous pyelogram

How Is Hematuria Managed in Older Adults?

The management of hematuria depends on the cause.

1. Enlarged Prostate: In older adults, medications or minimally invasive treatments are preferred. A combination of two classes of drugs; alpha-blockers for relaxing muscle tissues and 5-alpha reductase inhibitors for shrinking the prostate are found to be effective in the treatment of enlarged prostate.

2. Urinary tract infections: Antibiotics and increased water intake can relieve the symptoms of UTI. Drinking cranberry juice can also manage symptoms of UTI including hematuria.

3. Cancer: Cancer in the kidney, prostate, or bladder is treated by chemotherapy, radiation therapy, immunotherapy, and hormone therapy.

4. Kidney diseases: For treating kidney diseases, diuretics, and antihypertensives may be prescribed by physicians. Any complications in the kidney may require dialysis. In severe cases, even transplantation is performed.

How to Prevent Hematuria in Older Adults?

As hematuria is caused by many diseases, it is important to follow a healthy lifestyle that can prevent these diseases.

• Drinking plenty of water can prevent dehydration and reduce the severity of urinary tract infections. Many kidney diseases can also be prevented to a certain extent with a sufficient intake of water.

• Avoid smoking as it can cause cancer in the urinary tract.

• Don't rely too much on pain medications as they can produce blood in urine as a side effect.

• Minimize exposure to radiation, chemicals, metals, fumes, etc.

• Limit the intake of excess salts as it can cause high blood pressure and kidney stones.

• Vigorous physical or sexual activities are also related to hematuria. Hence, it is important to follow good hygiene after sexual intercourse.

• Individuals above 60 years of age are vulnerable to many diseases. Therefore, it is essential to undergo blood tests and urine tests every year to check or rule out any kidney-related diseases.

Conclusion

Hematuria or blood in urine commonly occurs in older adults. In older adults, it occurs commonly due to enlarged prostate and urinary tract infections. Hematuria can also occur due to many underlying conditions. It often presents as the first sign of many diseases. Urinary tract malignancies, kidney diseases, glomerulonephritis, pyelonephritis, urinary stone diseases, and inherited disorders can cause hematuria. The treatment of hematuria depends on the cause. However, following a healthy lifestyle can prevent or reduce the severity of hematuria.