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Forum Name: Miscellaneous Nephrology Topics

Question: blood in urine but no pain (pregnant)


 fruitie - Wed Jul 28, 2004 5:43 pm

For over 5 weeks now, I've experienced persistent blood in my urine (gross hematuria). It looks like a lot of blood to me, though I realize even a drop of blood can look like a lot in your urine. I have no pain whatsoever. I am now 19 weeks pregnant.

The urine was examined for bacteria several times. None were found. Conclusion = no infection.

The cells in the urine were tested to see if they indicated tumors. No such indication.

An ultrasound of the renal system was performed to look for masses or blockages or inflammation. No masses, blockages, or inflammation were detected on the bladder or either kidneys. The right kidney showed up with "echogenic" areas, which are supposedly harmless shadows, tissue, etc.

An incidental and seemingly unrelated finding of the ultrasound was that there seem to be lesions or hemangioma on my liver. Since it's unsafe to use contrasts, dyes, CTscans, MRIs, etc. for further exploration during pregnancy, we'll do another ultrasound in three months to check back on the state of the liver.

A blood test showed my blood count is 32 (while 36 is the low end of the normal range for pregnant females in my age group), presumably because of the blood being lost via the urine. I'm now taking iron supplements (2 Slow-FE tablets daily) to avoid becoming more anemic. The blood test indicated normal kidney function. It also indicated low potassium so I'm eating bananas daily.

A cystoscopy on the bladder (i.e. look via camera) was done to examine the health of the bladder walls and the emptying of the kidneys into the bladder. The bladder walls appeared completely healthy. The expulsion of fluid from the right kidney was a normal yellow urine color while the fluid expelled from the left kidney showed up as a red cloud of blood. So the left kidney or left ureter appear to be the source of the problem.

The latest theory is that there could be an AV malformation (arteriovenous malformation) at the left kidney or left ureter, irritated and now exposed to us by the pregnancy. Perhaps the growing uterus is applying pressue, causing weaker blood vessels to break. An AV malformation is defined as a tangle of abnormal vessels that forms an abnormal communication between the arterial and venous systems. Generally this is congenital. This condition happens to be very uncommon so I'm sort of skeptical that I may have managed to get unlucky enough to have it.

But the only other theories offered are (a) that there are small tumors in the left kidney, too small to be detected by the ultrasound or (b) that there are small stones in the left kidney, too small to be detected by the ultrasound. But (a) seems unlikely given that the kidney shows no inflammation and the kidney function came out normal on the blood test and I'm just not in the demographic for developing such conditions and (b) seems unlikely given that I have had no pain whatsoever yet expel a surprisingly significant amount of blood in the urine.

Without more invasive testing (scope of ureter and/or kidney) or the use of contrasts, dyes, CTscan, MRI, etc., all of which are not without risk during pregnancy, we can't determine whether or not there exists an AV malformation that is truly the cause, and we can't stop the bleeding.

Since there are no indications the bleeding is harming myself or the baby right now, the current plan is to just wait and see what happens. Hopefully, the condition won't worsen and we can wait until next year, after the baby is delivered, to investigate further.

This is all pretty scary to me, but it doesn't appear there's anything the doctors or I can do about it. :-( We're out of ideas.

Any thoughts or advice?
 Dr. Yasser Mokhtar - Mon Aug 09, 2004 7:18 pm

User avatar Dear Fruitie,

To have all this on top of the stress of pregnancy, that's a lot. But, i think you are holding up pretty well.

i think your doctors did and are still doing a great job.

i think the way to go after pregnancy is an angiogram during which an a-v malformation can also be coiled or embolized using different materials in the same procedure.

i think that the danger of getting fetal malformation from a ct scan now is low. Still the danger of exposing the fetus to radiation exists, this might lead to some childhood cancers. That's why it is not recommended to have a ct scan unless absolutely necessary.

i wish you good luck and a healthy outcome.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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