Microscopic hematuria

I think you are here as you are concerned if you have bladder cancer or not. Your new doctor is following AUA guideline for microhematuria that if a patient is over 40, check for the bladder cancer. If the doctor cannot find bladder cancer, the doctor may refer you to the kidney specialist because it is likely that you had inherited the disease called Thin Basement Membrane Disease (TBMD) which is the thining of the basement membrane of Glomerulus. TBMD allows blood in capillaries in Glowmerulus to escape. TBMD rarely progresses to chronic kidney disease where some other inheritable condition like Alport syndrome has higer risk to progress to chronic kidney disease. The fact your previous doctor did not refer you to the urologist was probably because it is likely he had dermined that everyone in your family with microhematuria is caused by TBMD.

My bet is that you do not have bladder cancer but rather hematuria you have been seen is due to something heredity which was passed down by your parents knowingly three members of your family had history of microhematuria.

1. The reason we see hematuria in bladder cancer patients is because some blood vessesl which feed nutritiants
and oxygen in blood to the tumor was broken. Those blood vessels are contructed by so called angiogenesis which is a hall mark of cancer to be able to bring in new blood vessels from near by blood vessel.
Luckily, those blood vessels are constructed rather fragile and the bladder expansion when urine filles up and contraction when urine is eliminated tend to break the blood vessels. If microscopic hematuria you had seen 30 years ago when you were teenager was actually because of the bladder caner, it had been fed with blood for 30 years and the tumor must have become huge. But, the ultra sound did not show anything.

2. Bladder cancer cannot be inherited. I had asked a genome scientist who has been working on bladder cancer if bladder cancer is hereditary. His answer was NO! ◦ You cannot “pass on” your cancer to your biological children ◦ Cancer-causing mutations occur in only a small subset of your cells and are not present in the sperm of males or the eggs of females.

3. Observing that 4 members of your family has experienced microscopic hematura, it is likely that you inherited some genes which cause microscopic hematuria. I have noticed that there are multiple microscopic hematuria conditions due to heridity. There is a condition called THIN BASEMENT MEMBRANE DISEASE. Its features are as follows. The link to the presentation is listed below.

- Familial (inherited) or sporadic : Typically augosomal dominant
- Equal portion of male and female patients
- Onset of hematuria typically in childhood/adolescence
- Can get gross hematuria, often in association with urinary tract infection
- Common cause of isolated glomerular hematuria : 20%-25% of patients referred to nephrology for persistent hematuria.
- GBM thinning screen on renal biopsy
- Hypertention, proteinuria, and progression to ESRD are rare
- Should be monitored over time a small risk of chronic kidney disease (<5%).

Microscopic Hematuria Time 22:30 talks about TBMD.




Familia ( inheritable) Hematuria Time 11:00 shows a chart. 1% of population has TBMD and no progression.



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I’m a 45 year old non smoker who has been diagnosed most of my life with microscopic hematuria. My mother, my grandfather and my father have had this issue. It was never a red flag for my previous doctor who retired two years ago. Due to the pandemic, I delayed my search for a new doctor. When I visited a new doctor, the doctor immediately referred me to urologist due to microscopic hematuria. The urinalysis results will display traces of blood. (2+) Urologist had me perform an ultrasound which was fine but now they want me to perform a cystoscopy and a ct scan. I wanted to get feedback from folks who have been diagnosed with Long term microscopic hematuria. I’ve been diagnosed with this since I was a teenager.