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Kidney Diseases

Ibuprofen and hematuria

10/17/2006

Question:

On my dipstick I have shown 2+ blood in my urine and all else was negative and the sediment was normal. I have been taking a lot of ibuprofen lately for a sore back. Would this cause this? How do I correct this? I have stopped taking the ibuprofen now.

Answer:

If the only abnormality on your urinalysis was 2+ blood, then it is unlikely that the ibuprofen is the cause.  When ibuprofen or other drugs in its class (the so-called "NSAIDs," or non-steroidal anti-inflammatory drugs) cause renal problems, they result in a combination of protein, blood, and white cells in the urine. 

If you are a male, the blood could be coming from the bladder, prostate, or kidneys.  If you are a female, blood could be coming from the bladder, vagina, or kidneys.  Causes of blood alone in the urine include kidney stones, cysts, tumors, low-level irritation or inflammation (of bladder, prostate, or kidneys), sickle cell trait, and blood vessel abnormalities (called AV malformations). 

The initial tests for patients with isolated hematuria (blood in the urine) generally include blood tests to determine kidney function, CBC ("complete blood count," including white/red cell and platelet counts), complete urinalysis including microscopic examination of the urine, and either a kidney ultrasound or intravenous pyelogram ("IVP," in which dye is injected into a vein and circulates to the kidneys, after which x-ray pictures are taken to show detailed kidney configuration). 

Depending on these results, sometimes a cystoscopy is needed: this is an examination in which a lighted flexible fiberoptic tube is inserted through the urethra into the bladder, allowing direct viewing of the bladder and prostate, and biopsy if needed.  Rarely a kidney biopsy may be needed. 

Anyway, the initial screening tests can be ordered by a primary care physician; if more complicated testing is required, this may require a referral to either a urologist (surgical kidney doctor) or nephrologist (medical kidney doctor).

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University