Leading expert in radiology and advanced imaging, Dr. Kent Yucel, MD, explains the critical role of kidney CT scans for diagnosing painless hematuria. He details how blood in urine without pain is a major red flag for kidney cancer and bladder cancer. Dr. Yucel outlines the three main categories of kidney disease and the specific imaging tests used for each. He clarifies when a normal kidney ultrasound still requires further investigation with CT or MRI. The interview provides essential guidance on confirming a diagnosis and seeking a medical second opinion for treatment planning.
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Diagnosing Painless Hematuria: When to Use Kidney CT and MRI Scans
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- Painless Hematuria Explained
- Imaging for Kidney Tumors
- Beyond Ultrasound: CT & MRI
- Diagnosing Urinary Blockage
- Medical Second Opinion
- Full Transcript
Painless Hematuria Explained
Painless hematuria is the medical term for blood in the urine without any associated pain. This symptom is a significant clinical warning sign. As explained by Dr. Kent Yucel, MD, it is a primary indicator of underlying serious conditions, most notably kidney cancer and urinary bladder cancer. The blood may be visible to the naked eye or only detectable under a microscope, a condition known as microhematuria. Regardless of visibility, its painless nature necessitates a thorough urological workup to rule out malignancy.
Imaging for Kidney Tumors
When painless hematuria is present, the diagnostic focus is on identifying or ruling out tumors. Dr. Kent Yucel, MD, categorizes kidney disease, placing tumors in a distinct group. Renal cell carcinoma is a common kidney cancer that often presents this way. The initial imaging test is typically a kidney ultrasound. However, Dr. Kent Yucel, MD, emphasizes a critical limitation: ultrasound can miss small kidney tumors. This is why further advanced imaging is often required, even after a normal ultrasound result, especially in older patients.
Beyond Ultrasound: CT & MRI
For a definitive diagnosis, doctors frequently move beyond ultrasound. Dr. Kent Yucel, MD, highlights CT urography and abdominal MRI as the advanced imaging modalities of choice. A kidney CT scan provides detailed, cross-sectional images that excel at detecting small masses in the kidneys, adrenal glands, and urinary bladder. An MRI of the kidneys offers similar detailed visualization and is particularly useful for further characterizing lesions found on other tests. These scans are essential components of the hematuria clinic workup protocol.
Diagnosing Urinary Blockage
Another category of kidney disease involves obstruction. Hydronephrosis, or water distention of the kidney, occurs when the ureter is blocked. Dr. Kent Yucel, MD, explains that ultrasound is the best first test to confirm the presence of this blockage. However, while ultrasound shows that a blockage exists, it is often poor at revealing the cause. To identify the reason for the obstruction, such as a stone or tumor, patients then proceed to a CT or MRI scan. This provides a clear picture of what is blocking the ureter.
Medical Second Opinion
Confirming a complex diagnosis like kidney cancer is crucial. Dr. Anton Titov, MD, and Dr. Kent Yucel, MD, discuss the importance of a medical second opinion. Reviewing CT findings and MRI results with another specialist ensures the accuracy of a renal carcinoma diagnosis. Furthermore, a second opinion helps patients and their doctors choose the very best treatment strategy, whether for renal cancer or bladder cancer. This process provides confidence that the planned course of action is optimal for the individual's specific condition.
Full Transcript
Kidney CT for blood in urine is a diagnostic test to rule out kidney cancer and urinary bladder cancer. Blood in urine without pain is called painless hematuria.
Dr. Anton Titov, MD: How are ultrasound, CT, and MRI used to diagnose kidney disease? When should CT or MRI be used, even if ultrasound of kidneys is normal?
A leading CT and MRI radiologist answers questions on the use of kidney CT in patients with blood in urine without pain (painless hematuria).
Kidney CT for blood in urine (painless hematuria) is used to diagnose kidney cancer. CT and MRI of the kidney are used for kidney cancer diagnosis. An abdominal MRI scan can find masses in kidneys, adrenal glands, and the urinary bladder.
Dr. Kent Yucel, MD: CT and MRI are also used in chronic kidney disease, but biopsy is the test of choice in medical kidney disease. Renal cell carcinoma is diagnosed by finding blood in urine (painless hematuria), CT urography, and flexible cystoscopy. Flexible endoscopic cystoscopy is also used in the diagnosis of urinary bladder cancer.
A medical second opinion confirms that CT and MRI findings of kidneys to detect renal carcinoma are accurate. It also helps to choose the best treatment strategy for renal cancer and urinary bladder cancer. Seek a medical second opinion on kidney cancer and be confident that your treatment is the best.
Magnetic resonance imaging of the renal arteries is also possible but is still in the testing phase. CT urography is a frequent diagnostic test in the hematuria clinic. Asymptomatic microhematuria requires CT urography and MRI of kidneys. Advanced imaging is also used for water distention of kidney diagnosis, hydronephrosis. MRI of kidneys is used to diagnose cancer or renal cell carcinoma.
Dr. Anton Titov, MD: To stay in the abdominal area, let's touch upon MRI and CT studies of the kidneys and adrenal glands. When is kidney MRI or kidney CT indicated? When can it benefit someone with a known or suspected kidney disease?
Dr. Kent Yucel, MD: Kidney disease falls into three categories. There is disease of the kidney itself that causes the kidneys to fail. That is usually evaluated by kidney biopsy, and there is very little role for imaging in kidney diseases of that kind. We call that diffuse or medical kidney disease.
Then there are kidney tumors. Renal tumors generally present with blood in the urine—blood that you can't see, or maybe blood that is only detectable by looking at the urine under the microscope.
Dr. Anton Titov, MD: Painless hematuria.
Dr. Kent Yucel, MD: We call that painless hematuria. Those tumors can be diagnosed by imaging. Ultrasound is usually the first choice, but ultrasound can also miss small tumors. So many older patients have blood in their urine; they may have renal CT or MRI scan even if ultrasound of kidneys is normal.
The third area of kidney disease is blockage of the urine coming out of the kidneys going into the bladder. That tube that leads from the kidneys into the bladder is called a ureter. So something is blocking a ureter; the name for it is hydronephrosis, or water distention of the kidney. That is evaluated by ultrasound primarily.
Similar to the bile duct situation, ultrasound is very good at showing blockage, but it is not so good at showing the cause of blockage. Sometimes there is no blockage; then patients are generally done with that imaging of the kidney. But if ultrasound shows blockages, then they will generally go on to the next diagnostic step: CT or MRI of the kidneys. It can show what is causing the blockage.
Kidney CT for blood in urine (painless hematuria) video interview with a leading expert in radiology. CT urography is used for renal and urinary bladder cancer diagnosis.