Norm for blood in the urine???

[nckdl]

My mother's best friend has just found out she has bladder cancer. If that's not bad enough, she has had s/s for 6 months!! I know she has had blood in her urine and have been going to her primary Dr. and he stated it's probably a kidney infection here is your Atb. No u/a done. It would go away for a week then return and she would return to the doctor. She even asked if she needed a specimen and they would say no and give her another atb. This happened a total of 4 times.Well she went for her yearly at the gyno and he did a u/a and found the abnormal cells. Don't they usually do a u/a? What about cystogram or Ivp? Ultrasounds or something? I mean if I would have known this was happening I would have told her it wasn't right but it's too late now. Man that gyno was mad. :angryfire It is so sad for a mid 40's women to have to go through with this.

[leslie :-D]

yes, a ua should have been the initial test.

if remarkable, and in the absence of a uti, then further tests were indicated.

leslie

[ICRN2008, BSN, RN]

The normal range for urine RBCs is 0-5 per high powered field. This test is relatively sensitive by not very specific for cancer of the urinary tract. The presence of abnormal epithelial cells (especially transitional epithelials) in the urine is another finding that warrants further investigation.

http://kidney.niddk.nih.gov/kudiseases/pubs/hematuria/

I hope that your mom's friend is successful in her treatment.

[VivaLasViejas, ASN, RN]

I'm sorry about your mom's friend.

Blood in the urine can be a symptom of so many different disorders that it could take literally thousands of dollars' worth of tests to diagnose the problem, which in a person of her age usually is NOT cancer. Sometimes it's a urinary tract infection, or more often, kidney stones; the latter tend to lacerate the delicate tissues in the kidneys or ureters as they move through the urinary tract, and cause microscopic or even visible blood in the urine.

However, a simple urinalysis can't tell you the exact cause of bleeding. Sometimes a primary care doctor will refer a patient to a urologist if treating for a UTI or kidney infection doesn't put an end to things; that's when CT scans (which easily diagnose stones) and KUB (X-rays of the kidneys, ureters, and bladder) are done. THEN if the cause isn't determined, they have to do more invasive things.

I doubt many internal med docs or family practitioners would suspect urinary tract cancer in a woman in her mid-40s, so it's not surprising that your mom's friend wasn't diagnosed promptly. Bladder cancer is most often seen in men and older women, smokers, alcohol abusers, and people who have been exposed to certain chemicals in the workplace over a period of years. To be honest, I don't think this lady's care was poor, or that the MD was negligent...........it's just very unfortunate. I hope she does OK.

[Jolie, BSN]

I'm sorry about your mom's friend.

I doubt many internal med docs or family practitioners would suspect urinary tract cancer in a woman in her mid-40s, so it's not surprising that your mom's friend wasn't diagnosed promptly. Bladder cancer is most often seen in men and older women, smokers, alcohol abusers, and people who have been exposed to certain chemicals in the workplace over a period of years. To be honest, I don't think this lady's care was poor, or that the MD was negligent...........it's just very unfortunate. I hope she does OK.

I would agree with this IF the patient had only been to the doctor once or twice complaining of blood in the urine. Of course, the doctor needs to rule out the most likely cause of these symptoms first (infection), before considering something far less likely but more serious.

However, after 4 trips to the doctor with no basic lab testing of the urine, just a series of ineffective prescriptions, I have to say that I think the doctor was overly lax. In this day and age of antibiotic resistance, it is negligent to prescribe repeated courses of antibiotics without a culture and sensitivity. That alone should have prompted the doctor to do basic urine studies, especially since the patient requested them.

I don't mean to imply any malice on the doctor's part. I'm sure s/he feels terrible for this situation, and hopefully will learn an important lesson that persistant symptoms warrant a work-up.

My prayers to the patient and her family.

[JoMom4]

As a nurse who worked in a urology office, I have seen this scenerio before. It makes me so angry when a PCP's office assumes it is a UTI just because the person is young. If hematuria continues after one round of antibiotics, the person should be referred to a urologist, who will make the decision to xray for possible stones, or cysto in the office for bladder tumor. Gross hematuria is not normal, and the MA's in PCP's offices need to know this.