Q. Patient in her late 60s is experiencing shortness of breath, weakness in her legs (less mobility as a result) and blood in her urine. Any thoughts?

A. Blood in the urine is termed hematuria. This can be caused by bleeding in any part of the urinary tract (from the kidneys, ureters (that connect the kidneys to the bladder), bladder, or urethra. In this case, there is accompanied weakness and shortness of breath. Anemia, which is a low blood count, which may be caused by prolonged hematuria, may cause both of these symptoms. A bladder tumor must be ruled out. Various kidney diseases also need to be excluded. Also, various inflammatory diseases such as Lupus or Polymyositis should be excluded.

Several blood tests, urine analysis and culture, kidney ultrasound, intravenous pyelogram (IVP) and cystoscopy (placing a scope through the urethra looking into the bladder) should be done. An internist and urologist should be able to help guide you. If the diagnosis is still uncertain, a nephrologist (kidney specialist) should likely be consulted.

Ref: National Kidney and Urologic diseases: http://www.niddk.nih.gov/health/kidney/nkudic.htm

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