Brief Answer:
could be benign

Detailed Answer:
Hello,

this finding requires at least some radiological investigation. Although 4-5 red blood cells per high power field is not a very high number, it's no normal either. Some very common causes include infection, obstruction, other inflammatory conditions (like glomerulonephritis) and tumors.

Red blood cells in the urine requires careful assessment of the urinary tract to exclude tumors, particularly in painless situations like yours. The urinalysis may indicate signs of infection like bacteriuria, nitrates, white blood cells, etc.

An ultrasound scan of the urinary tract is a good initial test. A CT scan is a more detailed test.

If the CT is clear, then the tumor scenario can be nearly excluded.

Passage of kidney stones thought the urinary tract, may cause the presence of red blood cells in the urine even without pain (although pain is usually present).

The stones are also visible on the CT scan.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!

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Brief Answer:
I've read it...

Detailed Answer:
I've read the whole question.
It doesn't matter that you had red blood cells in one specimen only. It could be a benign reason or a malignant one, although the first sounds more probable than the latter.
Cytology testing does not exclude cancer. You'll need at least 3 negative samples for that, and even then it's not accurate.

The radiological investigation (at least an ultrasound scan) is required. As I've pointed out in my first answer, in painless hematuria (even a transient one) tumors have to be ruled out. The only non-invasive way to do that, is by conducting appropriate radiological tests.

Kind Regards!

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Brief Answer:
I agree with this plan

Detailed Answer:
Most doctors would agree with this plan. If an upper urinary tract inflammatory origin (glomerulonephritis) can be reasonably excluded (no protein in the urine) then an ultrasound scan of the urinary tract and cystoscopy should suffice to exclude most malignant diagnoses. I would agree against the CT at this point, unless the ultrasound scan detects suspicious findings (because of the radiation, despite its higher accuracy for tumors and stones).

I can't say whether it's indicative of an infection. Infections usually give consistent results unless properly treated. You've told me about red blood cells only... no white blood cells, no nitrates, no bacteriuria...
This makes infection a less probable cause. It can't be excluded though.

Regarding the prior negative dipstick test, it does matter. It reduces the risk for serious conditions, but again it doesn't exclude them. Since tumors are suspected, they have to be reasonably excluded (with radiological tests). The cystoscopy is a minimally invasive test, but the best one for the bladder and I won't argue against its use.

Kind Regards!

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Brief Answer:
Of course you can...

Detailed Answer:
A negative urine culture is consistent with the results we've talked about. Infection is not very likely.

Of course you can breastfeed your toddler. There is nothing to worry about it! No harm can be done even in the worst case. And even about the hematuria, although the worst case scenario has to be excluded (because of its significance), other scenarios are much more likely. Please also take into account that a transient mild microscopic hematuria may be characterized idiopathic in more than half of the cases!

Best wishes!

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Brief Answer:
I don't believe this is the cause

Detailed Answer:
I understand how babies may be overactive particularly when breastfeeding but I don't believe this is the cause. Getting kicked while breastfeeding is so common (for all women) that all medical books would have kicking in the top of their differential diagnosis lists, if it were possible to cause hematuria!

Kind Regards!

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