Macroscopic haematuria is a condition characterized by the presence of blood in urine that is visible without a microscope. People above 50 years old with macroscopic haematuria are at higher risk of having a urological malignancy. People with macroscopic haematuria have urine that is red, or brown due to the presence of red blood cells (RBCs). Most people with macroscopic haematuria do not have other symptoms, but may have pain due to presence of blood clots in the urine. There are various possible causes that may be involved for the development of macroscopic haematuria. The common causes are:

• Inflammation of urinary bladder, urethra or prostate
• Presence of kidney or ureter stones
• Polycystic Kidney disease or glomerulonephritis
• Blood clotting disorders
• Sickle cell disease

• Cancer of kidneys, bladder or prostate
• Trauma

Discoloration of the urine is not always due to bleeding; the other possible causes are as follow:

• Porphyria (genetic disorder with impaired haemoglobin)
• Methaemoglobin (brownish-red, oxidised form of haemoglobin formed in the blood by the action of certain drugs)
• Certain medications
• Excessive beetroot consumption

As macroscopic haematuria indicates higher prevalence of malignancy, patients should be further evaluated for suspected urological disease as the cause of macroscopic haematuria. The diagnostic techniques commonly used are:

• Upper Tract Imaging with CT IVP, Ultrasound or MRI
• Urinary cytology and MSU m/c/s with RBC Morphology
• Cystoscopy : A cystoscopy is an examination of the inside of the bladder and urethra, the tube that carries urine from the bladder to the outside of the body

The treatment of macroscopic haematuria depends on the underlying cause. Macroscopic haematuria can be caused by a variety of conditions. Therefore, if you ever see blood in your urine, you should contact your urologist immediately.