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Hi Dr. Goldstein
Thank you for taking the time to answer my question.  I have been experiencing significant right side back (directly under the ribcage) pain for some time now,  that is coupled with blood/clots in the urine.  I put it off to a UTI and ignored it for quite some time as I had no real other symptoms.  Recently, I've developed more typical UTI symptoms, urgency, burning and a pain (almost an ache)in the groin.  Went to my endo who didn't seem overly concerned, but ordered a microalbumin,creatinine and microab/creat ratio.  Those numbers came back as:
Creatinine          27.2
Microalb/Creat Ratio    133.8
Microalbumin, urine     36.4

I've been drinking tons of cranberry juice, but it doesn't seem to help all that much.  
Is there reason for concern or can I wait for my body to deal with whatever is wrong?

Thank you for your time.

andey

Answer
Andey, you need to see a urologist! There are many possible causes for blood in the urine (hematuria).  The origin of the bleeding can come from the upper (kidneys or ureters) or lower (bladder, prostate, urethra) urinary tract.  Blood seen only under the microscope (microscopic hematuria) is usually of a benign nature whereas gross hematuria is potentially more serious. With gross hematuria, it is important to note the relationship of the bleeding to the urinary stream.  If at the beginning of urination (initial hematuria), the source of the blood is almost always in the urinary canal (urethra).  If at the end of urination (terminal hematuria), the source is usually the prostate gland in men or the bladder neck in men and women.  Bleeding throughout the entire stream (total hematuria) is due to bleeding that is initiated in the urinary bladder or upper urinary tract (kidneys and/or ureters).  

Some of the common causes of hematuria include infection, tumors, stones, and trauma (injury).  Assuming your right sided pain is related to the hematuria, you most likely have something going on in the right kidney.  The most common cause would be a urinary stone but other etiologies such as tumor need to be excluded.  In order to determine what is going on, it is necessary to consult a urologist.  A history, physical examination, urine cytology, and other laboratory tests are done.  In recent years, the FISH assay of the urine has been used in lieu of or in place of the urinary cytology.  This test has proven to be much more sensitive and specific in detecting bladder cancer in voided urine specimens or bladder washings. Visualization of the kidneys by imaging studies (ie IVP, ultrasound, CT or MRI) and examination of the lower urinary tract with a cystoscope are usually required as well.  Treatment cannot be recommended until a proper diagnosis is established.  I would not wait any longer for your body to deal with it!

In summary, consultation with a urologist is needed to determine the cause and seriousness of the hematuria.  Good luck!

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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