Haematuria (adult)

Haematuria occurs when blood enters the urinary collecting system and is excreted in the urine. There are many aetiologies for haematuria, and they range from benign and transient to gravely concerning. Haematuria can derive from the kidneys, ureters, bladder, prostate (in men), or urethra. Imaging can often be useful to determine the source.

Haematuria can be considered in two main forms:

  • frank (macroscopic) haematuria
  • microscopic haematuria


Frank haematuria

Frank haematuria is considered >1 mL of blood in the urine. Red-coloured urine (more red than brown) or clots in the urine is suggestive of a lower urinary tract source.

Microscopic haematuria

Microscopic haematuria may be either symptomatic or asymptomatic and is defined as ≥3 red blood cells per high-powered field (HPF) on 2 out of 3 urinalysis specimens 2.

Treatment and prognosis

Frank haematuria is almost always evaluated clinically, with cystoscopy, and with imaging (e.g. CT urogram).

Imaging workup for microscopic haematuria is controversial. Some academic societies advocate that in the absence of a known benign aetiology (such as vigorous exercise, infection, or menstruation), then a CT urogram is warranted 3,4. If the patient has known renal disease then an ultrasound of the kidneys and bladder may be more appropriate.

Some feel that the imaging workup in the setting of microscopic haematuria has a high negative rate for malignancy, and suggest that instead of imaging all patients with microscopic haematuria, imaging should be reserved for higher-risk subsets 5.

Microscopic haematuria in children has a different treatment algorithm.

Share article

Article information

rID: 39589
System: Urogenital
Synonyms or Alternate Spellings:
  • Hematuria
  • Hematuria (adult)
  • Blood in urine

Support Radiopaedia and see fewer ads

Updating… Please wait.

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.