Urgent ReferralVisible haematuria (blood you can see) in adults over 45 — or over 60 with microscopic haematuria + dysuria/raised WBC — requires 2-week wait urgent urology referral to exclude bladder or kidney cancer.
Causes by Type
| Type | Common Causes | Key Feature |
|---|---|---|
| Visible (gross) haematuria | Bladder cancer, kidney cancer, kidney stones, severe UTI | Always investigate in adults >45 |
| Microscopic haematuria + UTI symptoms | Cystitis, urethritis, prostatitis | Treat UTI; recheck after treatment |
| Microscopic haematuria, no symptoms | IgA nephropathy, thin glomerular basement membrane, exercise | Kidney function + protein check |
| Haematuria + loin pain | Renal stones, renal tract tumour, pyelonephritis | Imaging (CT urogram/USS) |
| Cola-coloured urine | Glomerulonephritis (blood + protein), haemolysis, myoglobinuria | Urgent nephrology or A&E assessment |
Dipstick Positive — Confirm with MicroscopyA positive dipstick can be caused by haemoglobin or myoglobin (not red cells). Always confirm with urine microscopy to detect actual red blood cells — particularly important before deciding on referral.
Is blood in urine always serious?
Not always. UTI and kidney stones are common and usually benign. However, visible haematuria in adults, particularly without pain (painless haematuria), is a red flag for urological cancer — always investigate urgently.
What is IgA nephropathy?
The most common glomerulonephritis globally — characterised by microscopic haematuria with episodic visible haematuria (often following a throat infection). Caused by IgA deposits in glomeruli. Can slowly progress to CKD.
Can exercise cause blood in urine?
Yes — vigorous exercise (especially running) can cause transient microscopic haematuria. It resolves within 72 hours of rest. If persistent, investigate for underlying cause.
What tests investigate haematuria?
Urine dipstick → microscopy → culture. Upper tract: CT urogram or renal ultrasound. Lower tract: flexible cystoscopy (bladder camera). Blood: eGFR, ACR, urine PCR.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.