Red urine is often indicative of hematuria, or blood in the urine. However, there are many causes of red urine, and it should not automatically be assumed that red urine indicates bleeding. Vegetable dyes, drugs such as phenazopyridine (Pyridium), and excessive ingestion of beets can cause red urine. When it is determined that the urine is red as a result of the presence of blood, the hematuria is termed gross hematuria. Hematuria may be the first symptom of serious disease of the urinary tract. Ask the following questions of any patient with the symptom of red urine:
How long have you noticed red urine?'' Have you had red urine previously?''
Have you noticed that the urine starts red and then clears? starts clear and then turns red? is red throughout?''
Have you noticed clots of blood in the urine?''
' 'Have you done any severely strenuous physical activity recently, such as prolonged hiking, running, or marching?''
Did you have an upper respiratory infection or a sore throat a few weeks ago?''
Is the red urine associated with flank pain? abdominal pain? burning sensation on urination? fever? weight loss?''
Are you aware of any bleeding problems?''
Are you taking any medications?''
Do you eat beets often?''
Individuals who participate in strenuous activities may traumatize blood cells as these cells travel through the small vessels in the feet. A condition called march hemoglobinuria may result,
causing intravascular hemolysis and hemoglobinuria. The temporal relationship of blood in the urine is an important factor. Blood only at the beginning, or initial hematuria, usually has a source in the urethra. Blood only at the end of urination, or terminal hematuria, indicates a disorder at the bladder neck or the posterior urethra. Blood evenly distributed throughout urination is total hematuria and implies disease above the prostate gland or a massive hemorrhage at any level. Blood staining of undergarments without blood in the urine indicates pathologic processes in the external urethral meatus. Weight loss and hematuria are seen in renal cell carcinoma. Red urine that occurs 10 to 14 days after an upper respiratory infection may indicate acute glomerulonephritis.
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