Materiały źródłowe

• #1 Hematuria – Wikipedia

  https://en.wikipedia.org/wiki/Hematuria

  Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. „Gross hematuria” occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods (e.g. blackberries, beets, food dyes) can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation (e.g. laboratory testing) can help determine the underlying cause.

• #2 Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15234-hematuria

  Many things can cause blood in your urine, including urinary tract infections, vigorous exercise and chronic kidney disease. But you shouldnt ignore it. Healthcare providers can diagnose the cause and recommend the best treatment. […] Hematuria (hee-muh-TOOR-ee-uh) is the medical name for the presence of blood cells in your urine (pee). […] But if you notice your pee looks pink or red or you have other hematuria symptoms, it might be a sign that something is wrong. You should reach out to a healthcare provider. […] Healthcare providers label blood in pee as: Gross hematuria. This is when theres enough blood in your pee that its visible to the naked eye. It can turn toilet water a pale pink or bright red color. Microscopic hematuria. If you have microscopic hematuria (microhematuria), you have blood in your pee, but the amount is too small for you to see with your naked eye. You need a microscope to see it. Dipstick hematuria. Dipstick hematuria occurs when oxidation (exposure to oxygen) of a dipstick causes a color change.

• #3 Blood in Urine – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/symptoms-of-kidney-and-urinary-tract-disorders/blood-in-urine

  Blood in the urine (hematuria) can make urine appear pink, red, or brown, depending on the amount of blood, how long it has been in the urine, and how acidic the urine is. An amount of blood too small to change color of the urine (microscopic hematuria) may be found by chemical tests or microscopic examination. […] People who notice blood in their urine should see their doctor within 1 or 2 days. However, people who are passing a large amount of blood, who are unable to urinate, or who have severe pain should see a doctor right away. […] Doctors first try to establish that bleeding is the cause of red urine. Then they look for the cause of the bleeding, including where in the urinary tract (or occasionally elsewhere) the bleeding is originating. […] Testing is needed to determine the cause (or sometimes the presence) of blood in the urine. Urinalysis is the first test done. Urinalysis can detect blood (confirming that the red color of the urine is caused by blood) and may show evidence of a kidney filtering disorder.

• #4 Blood in urine (hematuria) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/blood-in-urine/symptoms-causes/syc-20353432

  It can be scary to see blood in urine, also called hematuria. In many cases, the cause is harmless. But blood in urine also can be a sign of a serious illness. […] Either way, it’s important to figure out the reason for the bleeding. […] Treatment depends on the cause. […] See a health care provider whenever urine looks like it might have blood in it. […] It can be hard to tell whether a change of urine color is caused by blood. That’s why it’s always best to get a checkup. […] This condition happens when the kidneys or other parts of the urinary tract let blood cells leak into urine. […] Different problems can cause this leaking to happen, including: […] Blood in urine that can be seen only in the lab is a common symptom of a kidney disease called glomerulonephritis. […] Blood in urine that can be seen with the naked eye may be a sign of advanced kidney, bladder or prostate cancer.

• #5 Assessment of Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0515/p1748.html

  Microscopic hematuria, a common finding on routine urinalysis of adults, is clinically significant when three to five red blood cells per high-power field are visible. […] Patients with proteinuria, red cell casts, and elevated serum creatinine levels should be referred promptly to a nephrology subspecialist. […] Patients with asymptomatic microscopic hematuria or with hematuria persisting after treatment of urinary tract infection also need to be evaluated. […] Because upper and lower urinary tract pathologies often coexist, patients should be evaluated using cytology plus intravenous urography, computed tomography, or ultrasonography. […] When urine cytology results are abnormal, cystoscopy should be performed to complete the investigation. […] The American Urological Association (AUA) defines clinically significant microscopic hematuria as three or more red blood cells per high-power field on microscopic evaluation of urinary sediment from two of three properly collected urinalysis specimens.

• #6 Gross and Microscopic Hematuria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534213/

  The minimum criteria used by the 2020 American Urological Association Microhematuria Guideline to diagnose microhematuria is the unexplained finding in an uncentrifuged specimen on microscopic evaluation of 3 RBC/HPF. […] A microscopic examination of the urinary sediment must always confirm a presumptive diagnosis of microhematuria by dipstick. […] The most severe and devastating consequence of hematuria is malignancy. Many classifications exist to stratify patients into low-, intermediate-, and high-risk; a commonly used and validated system is the 2020 American Urological Association Guideline on Microhematuria Risk Stratification Guide. […] A primary focus of an evaluation of hematuria is to identify and exclude any underlying malignancy; hematuria is the presenting symptom in most bladder cancers. The overall incidence of discovering a genitourinary malignancy in patients with microscopic hematuria is approximately 3%. With gross hematuria, the incidence rises to 10% to 20%.

• #7 Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15234-hematuria

  A false-positive rate is when the dipstick test says you have blood in your pee, but you dont. Providers need to confirm dipstick hematuria with a microscopic urinalysis. […] Hematuria is common. Medical experts estimate that more than 20% of people who receive an evaluation from a urologist have blood in their pee. Microscopic hematuria affects an estimated 2% to 31% of people. Microscopic hematuria is more common than gross hematuria. […] Having blood in your pee doesnt always mean you have a condition. But it can be an important warning sign that something is wrong with your body. Dont ignore it. Contact a healthcare provider as soon as you find blood in your pee. […] A healthcare provider will review your medical history, ask you questions about any other symptoms and perform a physical examination, which may include a pelvic exam or digital rectal exam. They may also recommend additional tests to help confirm a hematuria diagnosis.

• #8 Blood in urine (hematuria) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/blood-in-urine/symptoms-causes/syc-20353432

  It can be scary to see blood in urine, also called hematuria. In many cases, the cause is harmless. But blood in urine also can be a sign of a serious illness. […] Either way, it’s important to figure out the reason for the bleeding. […] Treatment depends on the cause. […] See a health care provider whenever urine looks like it might have blood in it. […] It can be hard to tell whether a change of urine color is caused by blood. That’s why it’s always best to get a checkup. […] This condition happens when the kidneys or other parts of the urinary tract let blood cells leak into urine. […] Different problems can cause this leaking to happen, including: […] Blood in urine that can be seen only in the lab is a common symptom of a kidney disease called glomerulonephritis. […] Blood in urine that can be seen with the naked eye may be a sign of advanced kidney, bladder or prostate cancer.

• #9 Hematuria (Blood in the Urine) In Adults | National Kidney Foundation

  https://www.kidney.org/kidney-topics/hematuria-blood-urine-adults

  Hematuria means blood is in the urine. There are many causes in adults, including cancer, infection, and kidney stones. Testing and follow-up are key. […] Hematuria means that theres blood in the urine. Sometimes there is a clear cause, like a kidney stone or infection. But often the cause is not known. When the cause is not known and the hematuria is transient (goes away on its own within a short time), there is usually no problem. This is more common with people who are under 35 years of age. But for people who are older than 35, hematuria may be a sign of cancer, even if its transient. […] One or more of these tests may be done for hematuria, depending on your symptoms and the suspected cause. […] Urine tests: Urinalysis (urine test): A test strip is placed in urine and changes color if theres blood. This is just a screening test, so results must be confirmed by looking at the urine with a microscope.

• #10 Blood in Urine: When to Be Concerned & What to Know

  https://www.cancercenter.com/community/blog/2022/09/when-to-worry-about-blood-in-urine

  Patients should consult their doctor if they detect blood in their urine. Blood in your urine may be a symptom of a serious health problem, including cancer, so its important to determine the cause as quickly as possible. […] Bloody urine may be a symptom of a serious health problem, including cancer, so its important to determine the cause as quickly as possible. […] Blood in the urine, clinically known as hematuria, is caused when red blood cells from the kidneys, ureters, bladder or urethra have entered the urine stream. […] Hematuria is clinically classified as either: Gross, or visible while urinating or in the toilet water; Microscopic, or detected only through a urine test or under a microscope. […] If its a UTI, there should be pain, there should be discomfort, there should be changes in urination, not just blood in the urine alone.

• #11 Hematuria (Blood in the Urine) In Adults | National Kidney Foundation

  https://www.kidney.org/kidney-topics/hematuria-blood-urine-adults

  Hematuria means blood is in the urine. There are many causes in adults, including cancer, infection, and kidney stones. Testing and follow-up are key. […] Hematuria means that theres blood in the urine. Sometimes there is a clear cause, like a kidney stone or infection. But often the cause is not known. When the cause is not known and the hematuria is transient (goes away on its own within a short time), there is usually no problem. This is more common with people who are under 35 years of age. But for people who are older than 35, hematuria may be a sign of cancer, even if its transient. […] One or more of these tests may be done for hematuria, depending on your symptoms and the suspected cause. […] Urine tests: Urinalysis (urine test): A test strip is placed in urine and changes color if theres blood. This is just a screening test, so results must be confirmed by looking at the urine with a microscope.

• #12 Blood in Urine: When to Be Concerned & What to Know

  https://www.cancercenter.com/community/blog/2022/09/when-to-worry-about-blood-in-urine

  But cancer is always a concern with painless, gross hematuria, says Dr. Sadeghi. And thats why it must be properly evaluated. […] Painless, visible blood in the urine requires a urologic evaluation following a two-part process: Imaging, such as a CT scan, that examines the lining of the upper urinary tract and ureters; Cystoscopy, a procedure that uses a scope and a camera to examine the bladder and urethra. […] The No. 1 way bladder cancer is diagnosed is through visible, painless blood in the urine, Dr. Sadeghi says. […] Because of the concern about a possible cancer diagnosis, hematuria, especially the painless kind you can see, must always be taken seriously, Dr. Sadeghi says. […] If you have painless blood in the urine you can see, you must visit a urologist, he says. Theres no way around it. The condition cant be diagnosed by a primary care physician.

• #13 Gross and Microscopic Hematuria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534213/

  The minimum criteria used by the 2020 American Urological Association Microhematuria Guideline to diagnose microhematuria is the unexplained finding in an uncentrifuged specimen on microscopic evaluation of 3 RBC/HPF. […] A microscopic examination of the urinary sediment must always confirm a presumptive diagnosis of microhematuria by dipstick. […] The most severe and devastating consequence of hematuria is malignancy. Many classifications exist to stratify patients into low-, intermediate-, and high-risk; a commonly used and validated system is the 2020 American Urological Association Guideline on Microhematuria Risk Stratification Guide. […] A primary focus of an evaluation of hematuria is to identify and exclude any underlying malignancy; hematuria is the presenting symptom in most bladder cancers. The overall incidence of discovering a genitourinary malignancy in patients with microscopic hematuria is approximately 3%. With gross hematuria, the incidence rises to 10% to 20%.

• #14 Evaluation of visible hematuria – Differential diagnosis of symptoms | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/316

  Visible (gross) hematuria is urine that is visibly discolored by blood or blood clot. It may present as urine that is red to brown, or as frank blood. As little as 1 mL of blood can impart color to 1 L of urine. […] Visible hematuria, even when transient or asymptomatic, may indicate a significant disease process and always requires further investigation. Possible etiologies vary by age and the workup of visible hematuria differs among children, adults under the age of 35 years, and adults ages 35 years or older. […] Patients with visible hematuria represent a higher-risk group for urologic malignancy than those presenting with nonvisible hematuria. […] Visible hematuria is a presenting sign in more than 66% of patients with urologic cancer. […] The sensitivity of visible hematuria in revealing malignancy is significant: 0.83 for urothelial carcinoma of the bladder, 0.66 for ureteric carcinoma, and 0.48 in renal cell carcinomas. […] In men ages 60 years, the positive predictive value of visible hematuria for urologic malignancy is 22.1%, and in women of the same age it is 8.3%.

• #15 Blood in urine (hematuria) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/blood-in-urine/diagnosis-treatment/drc-20353436

  Cystoscopy allows a health care provider to view the lower urinary tract to look for problems, such as a bladder stone. Surgical tools can be passed through the cystoscope to treat certain urinary tract conditions. […] Cystoscopy allows a health care provider to view the lower urinary tract to look for problems in the urethra and bladder. Surgical tools can be passed through the cystoscope to treat certain urinary tract conditions. […] These tests and exams play a key role in finding a cause for blood in the urine: […] Urine tests. These can be used to diagnose blood in the urine. They also can be used weeks or months later to see if the urine still has blood in it. Urine tests also can check for a urinary tract infection or for minerals that cause kidney stones. […] Imaging tests. An imaging test is often needed to find the cause of blood in the urine. You might need a CT or MRI scan, or an ultrasound exam.

• #16 Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15234-hematuria

  A healthcare provider may recommend the following tests to help diagnose hematuria: Urinalysis. You pee in a special cup and a provider looks at its appearance and checks it for signs of conditions that cause hematuria. Urine culture. You pee in a special cup and a provider checks it for signs of infection. Urine cytology. You pee in a special cup and a provider checks for any abnormal-appearing cells. Cystoscopy. A provider inserts a small camera (cystoscope) through your urethra into your bladder to examine your urethra and bladder. Imaging tests. Noninvasive imaging tests including an ultrasound, CT scan and MRI produce images of your urinary system and other organs and structures. […] Hematuria treatment depends on its cause. A healthcare provider will use the information they collect from your medical history, physical exam and any test results to find the best treatment.

• #17 Hematuria: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/981898-overview

  Generally, hematuria is defined as the presence of 5 or more red blood cells (RBCs) per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. Hematuria can be either gross (ie, overtly bloody, smoky, or tea-colored urine) or microscopic. […] The first step in the evaluation of hematuria consists of a detailed history and a thorough physical examination. […] The laboratory tests ordered for the evaluation of hematuria must be based on the clinical history and the physical examination. Tests that may be helpful include the following: Urinalysis with careful microscopic review of the urine sample. […] A kidney biopsy is rarely indicated in the evaluation of isolated asymptomatic hematuria. Relative indications for performing a kidney biopsy in patients with hematuria are as follows: Significant proteinuria, Abnormal renal function, Recurrent persistent hematuria, Serologic abnormalities (abnormal complement, ANA, or dsDNA levels), Recurrent gross hematuria, A family history of end-stage renal disease.

• #18 Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics/print

  Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics) […] Hematuria is the medical term for red blood cells in the urine. […] Although seeing blood in the urine can be frightening, most of the time hematuria is not life threatening. However, it is important to investigate the cause of hematuria because, occasionally, it is caused by a serious condition. […] This article will review the potential causes, evaluation, and treatment of blood in the urine in adults. […] There are a number of tests available to determine the cause of hematuria. Most people do not need every single test. […] Urine tests can provide clues about the cause of hematuria. This may include a urinalysis, which is performed with a dipstick test and sometimes uses a microscope to analyze the contents of the urine.

• #19 Hematuria Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/981898-workup

  If hematuria is of glomerular origin, measurements of protein excretion and serology tests may be in order. […] The approach to the evaluation of hematuria varies among physicians and no single method applies in all circumstances. […] A kidney biopsy is rarely indicated in the evaluation of isolated asymptomatic hematuria. […] Cystoscopy is not generally required in children with nonglomerular hematuria. […] A comprehensive physical examination and a detailed history are indispensable to the evaluation of hematuria. […] The first step in this category is to direct the evaluation based on the symptoms or physical examination findings. […] The significance of the renal involvement, in most cases, correlates directly with the quantity of protein being excreted. Thus, the combination of asymptomatic microscopic hematuria and proteinuria seems to suggest that such patients are more likely to have significant renal disease. […] Asymptomatic microscopic hematuria is common in unselected populations of children. […] If the child has recurrence of the symptoms and associated hematuria or if the hematuria is persistent, referral to a pediatric nephrologist is recommended.

• #20 Blood in urine (hematuria) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/blood-in-urine/diagnosis-treatment/drc-20353436

  Cystoscopy allows a health care provider to view the lower urinary tract to look for problems, such as a bladder stone. Surgical tools can be passed through the cystoscope to treat certain urinary tract conditions. […] Cystoscopy allows a health care provider to view the lower urinary tract to look for problems in the urethra and bladder. Surgical tools can be passed through the cystoscope to treat certain urinary tract conditions. […] These tests and exams play a key role in finding a cause for blood in the urine: […] Urine tests. These can be used to diagnose blood in the urine. They also can be used weeks or months later to see if the urine still has blood in it. Urine tests also can check for a urinary tract infection or for minerals that cause kidney stones. […] Imaging tests. An imaging test is often needed to find the cause of blood in the urine. You might need a CT or MRI scan, or an ultrasound exam.

• #21 Blood in Urine: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/blood-in-urine/

  A urinalysis test checks a sample of your urine (pee). It can find a small amount of blood cells in your urine and other types of cells, chemicals, and substances. […] Having blood in your urine is called hematuria. The blood may make your urine or the water in the toilet bowl turn pink, red, or reddish brown. But you might not always be able to see the blood without a lab test. There are two main types of hematuria, based on whether you can see the blood: Gross hematuria is when you can see blood in your urine without having a test. Microscopic hematuria is when you can’t see small amounts of blood in your urine, but it can be seen under a microscope or is found using a urinalysis. […] A urinalysis, which includes a test for blood in urine, is used to check your general health, including the health of your urinary tract, kidneys, and liver. The test can also be used to check for other health problems besides blood in urine.

• #22 Gross and Microscopic Hematuria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534213/

  The evaluation of hematuria is often deficient, inadequate, or incomplete. More than half or more of the patients identified as having hematuria in primary care practices are not properly worked up or referred to urology promptly. Cystoscopy is underutilized overall, as there is a tendency to rely excessively on diagnostic imaging alone. […] Urinalysis is the initial and most useful test to detect hematuria. Although urine dipsticks are widely available and can be performed quickly, they can give false-positive or false-negative results and require microscopic analysis to confirm positive findings. The presence of 3 or more RBCs per high power field on microscopic examination of the urine sediment establishes the diagnosis, although there is no „safe” lower limit of hematuria. […] The standard evaluation for hematuria traditionally comprises urine cytology, upper tract imaging with an intravenous pyelogram, now considered obsolete, a CT urogram consisting of a CT of the abdomen and pelvis with and without IV contrast, and a cystoscopy. Cystoscopy is 98% sensitive in detecting bladder cancer. […] The current guideline recommendations for evaluating hematuria rely on a risk-stratification approach to avoid expensive, unnecessary, low-yield, and uncomfortable testing in lower-risk individuals.

• #23 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  The most important test in the evaluation of hematuria is a microscopic examination of the urine. […] According to the AUA, the presence of three or more red blood cells on a single, properly collected, noncontaminated urinalysis without evidence of infection is considered clinically significant microscopic hematuria. […] If the specimen shows large amounts of squamous epithelial cells (more than five per high-power field) or if the patient is unable to provide an uncontaminated specimen secondary to anatomic constraints (e.g., obesity, phimosis), catheterization should be used to obtain a specimen. […] If a patient has microscopic hematuria in the presence of pyuria or bacteriuria, a urine culture should be obtained to rule out urinary tract infection. […] If the hematuria has resolved after the infection has cleared, no further workup is needed. If hematuria persists, diagnostic evaluation should commence.

• #24 Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15234-hematuria

  A healthcare provider may recommend the following tests to help diagnose hematuria: Urinalysis. You pee in a special cup and a provider looks at its appearance and checks it for signs of conditions that cause hematuria. Urine culture. You pee in a special cup and a provider checks it for signs of infection. Urine cytology. You pee in a special cup and a provider checks for any abnormal-appearing cells. Cystoscopy. A provider inserts a small camera (cystoscope) through your urethra into your bladder to examine your urethra and bladder. Imaging tests. Noninvasive imaging tests including an ultrasound, CT scan and MRI produce images of your urinary system and other organs and structures. […] Hematuria treatment depends on its cause. A healthcare provider will use the information they collect from your medical history, physical exam and any test results to find the best treatment.

• #25 Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15234-hematuria

  A healthcare provider may recommend the following tests to help diagnose hematuria: Urinalysis. You pee in a special cup and a provider looks at its appearance and checks it for signs of conditions that cause hematuria. Urine culture. You pee in a special cup and a provider checks it for signs of infection. Urine cytology. You pee in a special cup and a provider checks for any abnormal-appearing cells. Cystoscopy. A provider inserts a small camera (cystoscope) through your urethra into your bladder to examine your urethra and bladder. Imaging tests. Noninvasive imaging tests including an ultrasound, CT scan and MRI produce images of your urinary system and other organs and structures. […] Hematuria treatment depends on its cause. A healthcare provider will use the information they collect from your medical history, physical exam and any test results to find the best treatment.

• #26 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  The upper urinary tract is best evaluated with multiphasic computed tomography urography, which identifies hydronephrosis, urinary calculi, and renal and ureteral lesions. […] The lower urinary tract is best evaluated with cystoscopy for urethral stricture disease, benign prostatic hyperplasia, and bladder masses. […] Voided urine cytology is no longer recommended as part of the routine evaluation of asymptomatic microscopic hematuria, unless there are risk factors for malignancy. […] In 2012, the American Urological Association (AUA) published an updated guideline on the diagnosis, evaluation, and follow-up of asymptomatic microscopic hematuria in adults. […] Based on the guideline, this article describes the current approaches to diagnosis, follow-up, and referral for patients with asymptomatic microscopic hematuria.

• #27 Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics/print

  Blood tests may be used to look for evidence of kidney or other diseases that can cause hematuria. […] Computed tomography, or CT scan, is a radiologic test that examines the structure of the kidneys, ureters, and bladder. […] Cystoscopy is a procedure that is most often done in an office setting but sometimes is done as a day surgery procedure. […] During cystoscopy, the clinician examines the lining of the bladder to determine whether there are any abnormalities. […] There is no one specific treatment for all cases of hematuria. Rather, treatment is aimed at the specific underlying cause, if a cause can be determined. […] If no underlying cause for hematuria is found during the initial evaluation, follow-up urine testing and blood pressure monitoring may be recommended every three to six months.

• #28 Assessment and management of haematuria in the general practice setting

  https://www1.racgp.org.au/ajgp/2021/july/haematuria-in-the-general-practice-setting

  Biochemical investigations including renal function, coagulation and haemoglobin should be performed to rule out any gross biochemical instability. […] Upper tract imaging is indicated prior to referral to urology services where possible to assist in guiding treatment. […] CT IVP is the gold standard for assessment of the urinary tract for malignancy; however, it exposes the patient to risk of contrast allergy and radiation, as well as increased costs. […] Urinary cytology is often included in the investigative work-up of patients with both macroscopic and microscopic haematuria; however, guideline recommendations regarding when it should be used are varied. […] Urological referral is recommended for all patients with gross haematuria, while patients presenting with microscopic haematuria should undergo a risk-stratified approach.

• #29 Blood in urine (hematuria) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/blood-in-urine/diagnosis-treatment/drc-20353436

  Cystoscopy allows a health care provider to view the lower urinary tract to look for problems, such as a bladder stone. Surgical tools can be passed through the cystoscope to treat certain urinary tract conditions. […] Cystoscopy allows a health care provider to view the lower urinary tract to look for problems in the urethra and bladder. Surgical tools can be passed through the cystoscope to treat certain urinary tract conditions. […] These tests and exams play a key role in finding a cause for blood in the urine: […] Urine tests. These can be used to diagnose blood in the urine. They also can be used weeks or months later to see if the urine still has blood in it. Urine tests also can check for a urinary tract infection or for minerals that cause kidney stones. […] Imaging tests. An imaging test is often needed to find the cause of blood in the urine. You might need a CT or MRI scan, or an ultrasound exam.

• #30 Blood in the Urine (Hematuria) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/blood-in-the-urine

  Renal ultrasound: A test utilizing sound waves to evaluate the size, shape and contour of the kidneys and urinary-collecting system. […] Because hematuria is a possible indicator of a health issue and not a disease itself, treatment will depend on an accurate diagnosis. […] By performing diagnostic tests, doctors can determine the source of bleeding. […] If due to an infection, a simple course of antibiotics may be the cure. […] If the problem is with the kidneys themselves, patients may be referred to a nephrologist for further management. […] If a malignancy or anatomic defect is the cause, surgery may be recommended. […] If it is determined that hematuria is from a benign cause, treatment may not be necessary.

• #31 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  The upper urinary tract is best evaluated with multiphasic computed tomography urography, which identifies hydronephrosis, urinary calculi, and renal and ureteral lesions. […] The lower urinary tract is best evaluated with cystoscopy for urethral stricture disease, benign prostatic hyperplasia, and bladder masses. […] Voided urine cytology is no longer recommended as part of the routine evaluation of asymptomatic microscopic hematuria, unless there are risk factors for malignancy. […] In 2012, the American Urological Association (AUA) published an updated guideline on the diagnosis, evaluation, and follow-up of asymptomatic microscopic hematuria in adults. […] Based on the guideline, this article describes the current approaches to diagnosis, follow-up, and referral for patients with asymptomatic microscopic hematuria.

• #32 Blood in the Urine (Hematuria) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/blood-in-the-urine

  The presence of red blood cells in urine. […] Symptoms include urine that turns pink, red, or brown. […] How is hematuria diagnosed? […] Physicians will run the proper tests to make an accurate diagnosis. Common tests include: […] Urinalysis: Laboratory examination of urine may reveal various cells and chemicals, such as red blood cells, white blood cells, infection or excessive protein. […] Blood tests: Laboratory examination of blood may reveal high levels of waste products, indicating kidney dysfunction. […] Cystoscopy: Also called cystourethroscopy. A scope, a flexible tube and viewing device, is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones. […] CT or MR urogram: A series of images obtained with IV contrast focused on the abdomen and pelvis to evaluate the urinary tract. This is done to detect tumors, abnormalities, kidney stones or any obstructions, and to assess renal blood flow.

• #33 Hematuria | Riley Children’s Health

  https://www.rileychildrens.org/health-info/hematuria

  A urine culture is a laboratory test to determine whether bacteria are growing in the urine. A positive urine culture indicates that a urinary tract infection is present. […] Blood tests look for high levels of waste products in the blood, which may indicate that the kidneys are not functioning properly and may be used to determine whether the immune system is functioning abnormally. […] An ultrasound is a test that uses sound waves to produce high-quality images of the kidneys and bladders, without causing discomfort to the child. This allows your doctor to detect problems such as kidney stones, structural abnormalities and obstructions to the flow of urine. […] A cystoscopy (also called a cystourethroscopy) is an examination of the inside of the urethra and bladder. The exam involves inserting a cystoscope—a flexible tube equipped with a camera—through the urethra and into the bladder.

• #34 Assessment and management of haematuria in the general practice setting

  https://www1.racgp.org.au/ajgp/2021/july/haematuria-in-the-general-practice-setting

  Biochemical investigations including renal function, coagulation and haemoglobin should be performed to rule out any gross biochemical instability. […] Upper tract imaging is indicated prior to referral to urology services where possible to assist in guiding treatment. […] CT IVP is the gold standard for assessment of the urinary tract for malignancy; however, it exposes the patient to risk of contrast allergy and radiation, as well as increased costs. […] Urinary cytology is often included in the investigative work-up of patients with both macroscopic and microscopic haematuria; however, guideline recommendations regarding when it should be used are varied. […] Urological referral is recommended for all patients with gross haematuria, while patients presenting with microscopic haematuria should undergo a risk-stratified approach.

• #35 Blood in urine (hematuria) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/blood-in-urine/diagnosis-treatment/drc-20353436

  Cystoscopy. A health care provider threads a narrow tube fitted with a tiny camera into your bladder to check for signs of disease. […] Sometimes the cause of blood in the urine can’t be found. In that case, you might need regular follow-up tests, mainly if you have risk factors for bladder cancer. These risk factors include smoking, radiation therapy to the pelvis or exposure to certain chemicals.

• #36 Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15234-hematuria

  A healthcare provider may recommend the following tests to help diagnose hematuria: Urinalysis. You pee in a special cup and a provider looks at its appearance and checks it for signs of conditions that cause hematuria. Urine culture. You pee in a special cup and a provider checks it for signs of infection. Urine cytology. You pee in a special cup and a provider checks for any abnormal-appearing cells. Cystoscopy. A provider inserts a small camera (cystoscope) through your urethra into your bladder to examine your urethra and bladder. Imaging tests. Noninvasive imaging tests including an ultrasound, CT scan and MRI produce images of your urinary system and other organs and structures. […] Hematuria treatment depends on its cause. A healthcare provider will use the information they collect from your medical history, physical exam and any test results to find the best treatment.

• #37 Patient education: Blood in the urine (hematuria) in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/blood-in-the-urine-hematuria-in-adults-beyond-the-basics/print

  Blood tests may be used to look for evidence of kidney or other diseases that can cause hematuria. […] Computed tomography, or CT scan, is a radiologic test that examines the structure of the kidneys, ureters, and bladder. […] Cystoscopy is a procedure that is most often done in an office setting but sometimes is done as a day surgery procedure. […] During cystoscopy, the clinician examines the lining of the bladder to determine whether there are any abnormalities. […] There is no one specific treatment for all cases of hematuria. Rather, treatment is aimed at the specific underlying cause, if a cause can be determined. […] If no underlying cause for hematuria is found during the initial evaluation, follow-up urine testing and blood pressure monitoring may be recommended every three to six months.

• #38 Assessment of Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0515/p1748.html

  The primary advantages of urine cytology versus cystoscopy is that because it is noninvasive, it does not cause the patient any discomfort. […] The AUA recommends that all patients older than 40 years and those who are younger but have risk factors for bladder cancer obtain cystoscopy to complete the evaluation of microscopic hematuria.

• #39 Hematuria Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/981898-workup

  If hematuria is of glomerular origin, measurements of protein excretion and serology tests may be in order. […] The approach to the evaluation of hematuria varies among physicians and no single method applies in all circumstances. […] A kidney biopsy is rarely indicated in the evaluation of isolated asymptomatic hematuria. […] Cystoscopy is not generally required in children with nonglomerular hematuria. […] A comprehensive physical examination and a detailed history are indispensable to the evaluation of hematuria. […] The first step in this category is to direct the evaluation based on the symptoms or physical examination findings. […] The significance of the renal involvement, in most cases, correlates directly with the quantity of protein being excreted. Thus, the combination of asymptomatic microscopic hematuria and proteinuria seems to suggest that such patients are more likely to have significant renal disease. […] Asymptomatic microscopic hematuria is common in unselected populations of children. […] If the child has recurrence of the symptoms and associated hematuria or if the hematuria is persistent, referral to a pediatric nephrologist is recommended.

• #40 Hematuria: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/981898-overview

  Generally, hematuria is defined as the presence of 5 or more red blood cells (RBCs) per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. Hematuria can be either gross (ie, overtly bloody, smoky, or tea-colored urine) or microscopic. […] The first step in the evaluation of hematuria consists of a detailed history and a thorough physical examination. […] The laboratory tests ordered for the evaluation of hematuria must be based on the clinical history and the physical examination. Tests that may be helpful include the following: Urinalysis with careful microscopic review of the urine sample. […] A kidney biopsy is rarely indicated in the evaluation of isolated asymptomatic hematuria. Relative indications for performing a kidney biopsy in patients with hematuria are as follows: Significant proteinuria, Abnormal renal function, Recurrent persistent hematuria, Serologic abnormalities (abnormal complement, ANA, or dsDNA levels), Recurrent gross hematuria, A family history of end-stage renal disease.

• #41 Hematuria: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/981898-overview

  Generally, hematuria is defined as the presence of 5 or more red blood cells (RBCs) per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. Hematuria can be either gross (ie, overtly bloody, smoky, or tea-colored urine) or microscopic. […] The first step in the evaluation of hematuria consists of a detailed history and a thorough physical examination. […] The laboratory tests ordered for the evaluation of hematuria must be based on the clinical history and the physical examination. Tests that may be helpful include the following: Urinalysis with careful microscopic review of the urine sample. […] A kidney biopsy is rarely indicated in the evaluation of isolated asymptomatic hematuria. Relative indications for performing a kidney biopsy in patients with hematuria are as follows: Significant proteinuria, Abnormal renal function, Recurrent persistent hematuria, Serologic abnormalities (abnormal complement, ANA, or dsDNA levels), Recurrent gross hematuria, A family history of end-stage renal disease.

• #42 Evaluation of visible hematuria – Differential diagnosis of symptoms | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/316

  Visible (gross) hematuria is urine that is visibly discolored by blood or blood clot. It may present as urine that is red to brown, or as frank blood. As little as 1 mL of blood can impart color to 1 L of urine. […] Visible hematuria, even when transient or asymptomatic, may indicate a significant disease process and always requires further investigation. Possible etiologies vary by age and the workup of visible hematuria differs among children, adults under the age of 35 years, and adults ages 35 years or older. […] Patients with visible hematuria represent a higher-risk group for urologic malignancy than those presenting with nonvisible hematuria. […] Visible hematuria is a presenting sign in more than 66% of patients with urologic cancer. […] The sensitivity of visible hematuria in revealing malignancy is significant: 0.83 for urothelial carcinoma of the bladder, 0.66 for ureteric carcinoma, and 0.48 in renal cell carcinomas. […] In men ages 60 years, the positive predictive value of visible hematuria for urologic malignancy is 22.1%, and in women of the same age it is 8.3%.

• #43 Hematuria (Blood in the Urine) – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine

  Hematuria means there is blood in your urine. […] Health care professionals use your medical history, a physical exam, and urinalysis to diagnose hematuria and help find the cause. […] Your health care professional will use urinalysis or a urine test to check a sample of your urine for blood. In some cases, your health care professional will test your urine again to confirm the diagnosis of hematuria. […] If urinalysis shows too many red blood cells in your urine, your health care professional may order one or more of the following tests. […] Health care professionals treat hematuria by treating the underlying cause of the hematuria. You may not need treatment if there is no serious condition causing your hematuria. […] Researchers are studying many aspects of hematuria, such as the accuracy of different diagnostic methods to detect bladder cancer in people with hematuria.

• #44 Blood in Urine: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/blood-in-urine/

  A urinalysis test checks a sample of your urine (pee). It can find a small amount of blood cells in your urine and other types of cells, chemicals, and substances. […] Having blood in your urine is called hematuria. The blood may make your urine or the water in the toilet bowl turn pink, red, or reddish brown. But you might not always be able to see the blood without a lab test. There are two main types of hematuria, based on whether you can see the blood: Gross hematuria is when you can see blood in your urine without having a test. Microscopic hematuria is when you can’t see small amounts of blood in your urine, but it can be seen under a microscope or is found using a urinalysis. […] A urinalysis, which includes a test for blood in urine, is used to check your general health, including the health of your urinary tract, kidneys, and liver. The test can also be used to check for other health problems besides blood in urine.

• #45 Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15234-hematuria

  A healthcare provider may recommend the following tests to help diagnose hematuria: Urinalysis. You pee in a special cup and a provider looks at its appearance and checks it for signs of conditions that cause hematuria. Urine culture. You pee in a special cup and a provider checks it for signs of infection. Urine cytology. You pee in a special cup and a provider checks for any abnormal-appearing cells. Cystoscopy. A provider inserts a small camera (cystoscope) through your urethra into your bladder to examine your urethra and bladder. Imaging tests. Noninvasive imaging tests including an ultrasound, CT scan and MRI produce images of your urinary system and other organs and structures. […] Hematuria treatment depends on its cause. A healthcare provider will use the information they collect from your medical history, physical exam and any test results to find the best treatment.

• #46 Blood in Urine: When to Be Concerned & What to Know

  https://www.cancercenter.com/community/blog/2022/09/when-to-worry-about-blood-in-urine

  But cancer is always a concern with painless, gross hematuria, says Dr. Sadeghi. And thats why it must be properly evaluated. […] Painless, visible blood in the urine requires a urologic evaluation following a two-part process: Imaging, such as a CT scan, that examines the lining of the upper urinary tract and ureters; Cystoscopy, a procedure that uses a scope and a camera to examine the bladder and urethra. […] The No. 1 way bladder cancer is diagnosed is through visible, painless blood in the urine, Dr. Sadeghi says. […] Because of the concern about a possible cancer diagnosis, hematuria, especially the painless kind you can see, must always be taken seriously, Dr. Sadeghi says. […] If you have painless blood in the urine you can see, you must visit a urologist, he says. Theres no way around it. The condition cant be diagnosed by a primary care physician.

• #47 Blood in Urine: When to Be Concerned & What to Know

  https://www.cancercenter.com/community/blog/2022/09/when-to-worry-about-blood-in-urine

  But cancer is always a concern with painless, gross hematuria, says Dr. Sadeghi. And thats why it must be properly evaluated. […] Painless, visible blood in the urine requires a urologic evaluation following a two-part process: Imaging, such as a CT scan, that examines the lining of the upper urinary tract and ureters; Cystoscopy, a procedure that uses a scope and a camera to examine the bladder and urethra. […] The No. 1 way bladder cancer is diagnosed is through visible, painless blood in the urine, Dr. Sadeghi says. […] Because of the concern about a possible cancer diagnosis, hematuria, especially the painless kind you can see, must always be taken seriously, Dr. Sadeghi says. […] If you have painless blood in the urine you can see, you must visit a urologist, he says. Theres no way around it. The condition cant be diagnosed by a primary care physician.

• #48 1 Minute Read: Hematuria Differential Diagnosis

  https://info.isabelhealthcare.com/blog/hematuria-differential-diagnosis

  Gross hematuria if transient or asymptomatic indicates a significant disease and should always be fully investigated. Blood clots may also be seen in the urine of patients with gross hematuria and may be painful to pass. […] To properly evaluate the urine specimen then a fresh, midstream, clean-catch or catheterized urine specimen must be collected and sent for analysis. Older patients with painless gross hematuria should be considered at high risk for malignancy and urine cytology should be performed.

• #49 Assessment and management of haematuria in the general practice setting

  https://www1.racgp.org.au/ajgp/2021/july/haematuria-in-the-general-practice-setting

  All patients presenting with gross haematuria require comprehensive evaluation to rule out malignant causes. […] Microscopic haematuria is a common incidental finding that can indicate underlying significant pathology; however, ultimately only 30% of patients are found to have an identifiable cause, either malignant or benign. […] Initial history and examination are important in patients with microscopic haematuria in order to prevent over-investigation by using risk stratification. […] Urine microscopy and culture should be reviewed for presence of squamous cells, leukocytes or organism culture. […] It is recommended that urinary tract infection be treated and repeat urine microscopy performed 6-12 weeks post-treatment to ensure resolution of haematuria, or alternatively onward referral for persistent haematuria.

• #50 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  Although routine screening for bladder cancer is not recommended, microscopic hematuria is often incidentally discovered by primary care physicians. The American Urological Association has published an updated guideline for the management of asymptomatic microscopic hematuria, which is defined as the presence of three or more red blood cells per high-power field visible in a properly collected urine specimen without evidence of infection. […] The most common causes of microscopic hematuria are urinary tract infection, benign prostatic hyperplasia, and urinary calculi. However, up to 5% of patients with asymptomatic microscopic hematuria are found to have a urinary tract malignancy. […] Dysmorphic red blood cells, cellular casts, proteinuria, elevated creatinine levels, or hypertension in the presence of microscopic hematuria should prompt concurrent nephrologic and urologic referral.

• #51 Hematuria – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hematuria/

  Identify and manage transient causes (e.g., UTI, nephrolithiasis); reassess for hematuria following treatment. […] Evaluate persistent hematuria based on suspected mechanism (e.g., glomerular vs. nonglomerular hematuria), regardless of whether the patient is receiving antiplatelet or anticoagulant therapy. […] Obtain trauma diagnostics if there are general indications for imaging in genitourinary trauma. […] Repeat the UA before pursuing further diagnostic evaluation if a benign etiology is suspected. […] Initial studies include BMP to evaluate renal function, urine dipstick to detect heme in urine, and urine microscopy to confirm 3 RBCs per HPF and assess for WBCs, bacteria, nitrites, RBC morphology, and protein. […] Dysmorphic RBCs, RBC casts, and/or significant proteinuria on urine microscopy suggest a glomerulopathy. […] Diagnosis of glomerular disease does not rule out urinary tract malignancy. […] Older age, male sex, and smoking are the main risk factors for urinary tract cancer.

• #52 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  The upper urinary tract is best evaluated with multiphasic computed tomography urography, which identifies hydronephrosis, urinary calculi, and renal and ureteral lesions. […] The lower urinary tract is best evaluated with cystoscopy for urethral stricture disease, benign prostatic hyperplasia, and bladder masses. […] Voided urine cytology is no longer recommended as part of the routine evaluation of asymptomatic microscopic hematuria, unless there are risk factors for malignancy. […] In 2012, the American Urological Association (AUA) published an updated guideline on the diagnosis, evaluation, and follow-up of asymptomatic microscopic hematuria in adults. […] Based on the guideline, this article describes the current approaches to diagnosis, follow-up, and referral for patients with asymptomatic microscopic hematuria.

• #53 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  The upper urinary tract is best evaluated with multiphasic computed tomography urography, which identifies hydronephrosis, urinary calculi, and renal and ureteral lesions. […] The lower urinary tract is best evaluated with cystoscopy for urethral stricture disease, benign prostatic hyperplasia, and bladder masses. […] Voided urine cytology is no longer recommended as part of the routine evaluation of asymptomatic microscopic hematuria, unless there are risk factors for malignancy. […] In 2012, the American Urological Association (AUA) published an updated guideline on the diagnosis, evaluation, and follow-up of asymptomatic microscopic hematuria in adults. […] Based on the guideline, this article describes the current approaches to diagnosis, follow-up, and referral for patients with asymptomatic microscopic hematuria.

• #54 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  The presence of microscopic hematuria and dysmorphic red blood cells, cellular casts, proteinuria, elevated creatinine level, or hypertension should raise suspicion for medical renal etiologies, such as immunoglobulin A nephropathy, Alport syndrome, benign familial hematuria, or other nephropathy. […] All patients with confirmed asymptomatic microscopic hematuria should provide a patient history and have a physical examination that includes blood pressure measurement and a laboratory assessment. […] Cystoscopy is recommended in all patients with asymptomatic microscopic hematuria who present with risk factors for malignancy, regardless of age. […] Cystoscopy can identify urethral stricture disease, benign prostatic hyperplasia, and bladder masses. […] If appropriate workup does not reveal nephrologic or urologic disease, then annual urinalysis should be performed for at least two years after initial referral.

• #55 Gross and Microscopic Hematuria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534213/

  The evaluation of hematuria is often deficient, inadequate, or incomplete. More than half or more of the patients identified as having hematuria in primary care practices are not properly worked up or referred to urology promptly. Cystoscopy is underutilized overall, as there is a tendency to rely excessively on diagnostic imaging alone. […] Urinalysis is the initial and most useful test to detect hematuria. Although urine dipsticks are widely available and can be performed quickly, they can give false-positive or false-negative results and require microscopic analysis to confirm positive findings. The presence of 3 or more RBCs per high power field on microscopic examination of the urine sediment establishes the diagnosis, although there is no „safe” lower limit of hematuria. […] The standard evaluation for hematuria traditionally comprises urine cytology, upper tract imaging with an intravenous pyelogram, now considered obsolete, a CT urogram consisting of a CT of the abdomen and pelvis with and without IV contrast, and a cystoscopy. Cystoscopy is 98% sensitive in detecting bladder cancer. […] The current guideline recommendations for evaluating hematuria rely on a risk-stratification approach to avoid expensive, unnecessary, low-yield, and uncomfortable testing in lower-risk individuals.

• #56 Hematuria (Blood in the Urine) In Adults | National Kidney Foundation

  https://www.kidney.org/kidney-topics/hematuria-blood-urine-adults

  Hematuria means blood is in the urine. There are many causes in adults, including cancer, infection, and kidney stones. Testing and follow-up are key. […] Hematuria means that theres blood in the urine. Sometimes there is a clear cause, like a kidney stone or infection. But often the cause is not known. When the cause is not known and the hematuria is transient (goes away on its own within a short time), there is usually no problem. This is more common with people who are under 35 years of age. But for people who are older than 35, hematuria may be a sign of cancer, even if its transient. […] One or more of these tests may be done for hematuria, depending on your symptoms and the suspected cause. […] Urine tests: Urinalysis (urine test): A test strip is placed in urine and changes color if theres blood. This is just a screening test, so results must be confirmed by looking at the urine with a microscope.

• #57 Hematuria – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hematuria/

  Identify and manage transient causes (e.g., UTI, nephrolithiasis); reassess for hematuria following treatment. […] Evaluate persistent hematuria based on suspected mechanism (e.g., glomerular vs. nonglomerular hematuria), regardless of whether the patient is receiving antiplatelet or anticoagulant therapy. […] Obtain trauma diagnostics if there are general indications for imaging in genitourinary trauma. […] Repeat the UA before pursuing further diagnostic evaluation if a benign etiology is suspected. […] Initial studies include BMP to evaluate renal function, urine dipstick to detect heme in urine, and urine microscopy to confirm 3 RBCs per HPF and assess for WBCs, bacteria, nitrites, RBC morphology, and protein. […] Dysmorphic RBCs, RBC casts, and/or significant proteinuria on urine microscopy suggest a glomerulopathy. […] Diagnosis of glomerular disease does not rule out urinary tract malignancy. […] Older age, male sex, and smoking are the main risk factors for urinary tract cancer.

• #58 Hematuria – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hematuria/

  Identify and manage transient causes (e.g., UTI, nephrolithiasis); reassess for hematuria following treatment. […] Evaluate persistent hematuria based on suspected mechanism (e.g., glomerular vs. nonglomerular hematuria), regardless of whether the patient is receiving antiplatelet or anticoagulant therapy. […] Obtain trauma diagnostics if there are general indications for imaging in genitourinary trauma. […] Repeat the UA before pursuing further diagnostic evaluation if a benign etiology is suspected. […] Initial studies include BMP to evaluate renal function, urine dipstick to detect heme in urine, and urine microscopy to confirm 3 RBCs per HPF and assess for WBCs, bacteria, nitrites, RBC morphology, and protein. […] Dysmorphic RBCs, RBC casts, and/or significant proteinuria on urine microscopy suggest a glomerulopathy. […] Diagnosis of glomerular disease does not rule out urinary tract malignancy. […] Older age, male sex, and smoking are the main risk factors for urinary tract cancer.

• #59 Blood in urine (hematuria) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/blood-in-urine/diagnosis-treatment/drc-20353436

  Cystoscopy. A health care provider threads a narrow tube fitted with a tiny camera into your bladder to check for signs of disease. […] Sometimes the cause of blood in the urine can’t be found. In that case, you might need regular follow-up tests, mainly if you have risk factors for bladder cancer. These risk factors include smoking, radiation therapy to the pelvis or exposure to certain chemicals.

• #60 Blood in urine (hematuria) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/blood-in-urine/diagnosis-treatment/drc-20353436

  Cystoscopy. A health care provider threads a narrow tube fitted with a tiny camera into your bladder to check for signs of disease. […] Sometimes the cause of blood in the urine can’t be found. In that case, you might need regular follow-up tests, mainly if you have risk factors for bladder cancer. These risk factors include smoking, radiation therapy to the pelvis or exposure to certain chemicals.

• #61 Gross and Microscopic Hematuria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534213/

  The minimum criteria used by the 2020 American Urological Association Microhematuria Guideline to diagnose microhematuria is the unexplained finding in an uncentrifuged specimen on microscopic evaluation of 3 RBC/HPF. […] A microscopic examination of the urinary sediment must always confirm a presumptive diagnosis of microhematuria by dipstick. […] The most severe and devastating consequence of hematuria is malignancy. Many classifications exist to stratify patients into low-, intermediate-, and high-risk; a commonly used and validated system is the 2020 American Urological Association Guideline on Microhematuria Risk Stratification Guide. […] A primary focus of an evaluation of hematuria is to identify and exclude any underlying malignancy; hematuria is the presenting symptom in most bladder cancers. The overall incidence of discovering a genitourinary malignancy in patients with microscopic hematuria is approximately 3%. With gross hematuria, the incidence rises to 10% to 20%.

• #62 Hematuria: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/981898-overview

  Generally, hematuria is defined as the presence of 5 or more red blood cells (RBCs) per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart. Hematuria can be either gross (ie, overtly bloody, smoky, or tea-colored urine) or microscopic. […] The first step in the evaluation of hematuria consists of a detailed history and a thorough physical examination. […] The laboratory tests ordered for the evaluation of hematuria must be based on the clinical history and the physical examination. Tests that may be helpful include the following: Urinalysis with careful microscopic review of the urine sample. […] A kidney biopsy is rarely indicated in the evaluation of isolated asymptomatic hematuria. Relative indications for performing a kidney biopsy in patients with hematuria are as follows: Significant proteinuria, Abnormal renal function, Recurrent persistent hematuria, Serologic abnormalities (abnormal complement, ANA, or dsDNA levels), Recurrent gross hematuria, A family history of end-stage renal disease.

• #63 Assessment and management of haematuria in the general practice setting

  https://www1.racgp.org.au/ajgp/2021/july/haematuria-in-the-general-practice-setting

  All patients presenting with gross haematuria require comprehensive evaluation to rule out malignant causes. […] Microscopic haematuria is a common incidental finding that can indicate underlying significant pathology; however, ultimately only 30% of patients are found to have an identifiable cause, either malignant or benign. […] Initial history and examination are important in patients with microscopic haematuria in order to prevent over-investigation by using risk stratification. […] Urine microscopy and culture should be reviewed for presence of squamous cells, leukocytes or organism culture. […] It is recommended that urinary tract infection be treated and repeat urine microscopy performed 6-12 weeks post-treatment to ensure resolution of haematuria, or alternatively onward referral for persistent haematuria.

• #64 Hematuria differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hematuria_differential_diagnosis

  Gross hematuria(GH) must be distinguished from pigmenturia, which may be due to endogenous sources (e.g., bilirubin, myoglobin,and porphyrins), foods ingested (e.g., beets and rhubarb), drugs (e.g., phenazopyridine), and simple dehydration. […] This distinction can be made easily by urinalysis with microscopy. Notably, myoglobinuria and other factors can cause false-positive chemical tests for hemoglobin, so urine microscopy is required to confirm the diagnosis of hematuria. […] GH also must be distinguished from vaginal bleeding in women, which usually can be achieved by obtaining a careful menstrual history, collecting the specimen when the patient is not having menstrual or gynecologic bleeding, or, if necessary, obtaining a catheterized specimen. […] Hematuria should be differentiated from other conditions which might mimic hematuria such as hemoglobinuria, myoglobinuria, porphyria, bile pigments, and alkaptonuria.

• #65 Hematuria Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/981898-workup

  The laboratory tests ordered for the evaluation of hematuria must be based on the clinical history and the physical examination. Identification of a glomerular and extraglomerular etiology of hematuria based on a good history and urine examination can help the physician to avoid requesting tests that may be unnecessary. […] Confirming that a child with red-colored urine has hematuria is mandatory. […] The urine dipstick test is currently one of the most useful and sensitive tools in detecting hematuria. […] The presence of hematuria is most important to confirm, since both normal and abnormal causes (eg, hemoglobinuria, myoglobinuria) can produce false-positive results. […] A urine culture should be obtained. Significant bacterial growth, indicative of urinary tract infection or pyelonephritis, requires antibiotic treatment and, possibly, further radiologic evaluation of the genitourinary tract for obstruction, vesicoureteral reflux, cystic disease, and other abnormalities.

• #66 Hematuria differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hematuria_differential_diagnosis

  Gross hematuria(GH) must be distinguished from pigmenturia, which may be due to endogenous sources (e.g., bilirubin, myoglobin,and porphyrins), foods ingested (e.g., beets and rhubarb), drugs (e.g., phenazopyridine), and simple dehydration. […] This distinction can be made easily by urinalysis with microscopy. Notably, myoglobinuria and other factors can cause false-positive chemical tests for hemoglobin, so urine microscopy is required to confirm the diagnosis of hematuria. […] GH also must be distinguished from vaginal bleeding in women, which usually can be achieved by obtaining a careful menstrual history, collecting the specimen when the patient is not having menstrual or gynecologic bleeding, or, if necessary, obtaining a catheterized specimen. […] Hematuria should be differentiated from other conditions which might mimic hematuria such as hemoglobinuria, myoglobinuria, porphyria, bile pigments, and alkaptonuria.

• #67 Hematuria differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hematuria_differential_diagnosis

  Gross hematuria(GH) must be distinguished from pigmenturia, which may be due to endogenous sources (e.g., bilirubin, myoglobin,and porphyrins), foods ingested (e.g., beets and rhubarb), drugs (e.g., phenazopyridine), and simple dehydration. […] This distinction can be made easily by urinalysis with microscopy. Notably, myoglobinuria and other factors can cause false-positive chemical tests for hemoglobin, so urine microscopy is required to confirm the diagnosis of hematuria. […] GH also must be distinguished from vaginal bleeding in women, which usually can be achieved by obtaining a careful menstrual history, collecting the specimen when the patient is not having menstrual or gynecologic bleeding, or, if necessary, obtaining a catheterized specimen. […] Hematuria should be differentiated from other conditions which might mimic hematuria such as hemoglobinuria, myoglobinuria, porphyria, bile pigments, and alkaptonuria.

• #68 Hematuria differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hematuria_differential_diagnosis

  Gross hematuria(GH) must be distinguished from pigmenturia, which may be due to endogenous sources (e.g., bilirubin, myoglobin,and porphyrins), foods ingested (e.g., beets and rhubarb), drugs (e.g., phenazopyridine), and simple dehydration. […] This distinction can be made easily by urinalysis with microscopy. Notably, myoglobinuria and other factors can cause false-positive chemical tests for hemoglobin, so urine microscopy is required to confirm the diagnosis of hematuria. […] GH also must be distinguished from vaginal bleeding in women, which usually can be achieved by obtaining a careful menstrual history, collecting the specimen when the patient is not having menstrual or gynecologic bleeding, or, if necessary, obtaining a catheterized specimen. […] Hematuria should be differentiated from other conditions which might mimic hematuria such as hemoglobinuria, myoglobinuria, porphyria, bile pigments, and alkaptonuria.

• #69 Hematuria differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hematuria_differential_diagnosis

  Gross hematuria(GH) must be distinguished from pigmenturia, which may be due to endogenous sources (e.g., bilirubin, myoglobin,and porphyrins), foods ingested (e.g., beets and rhubarb), drugs (e.g., phenazopyridine), and simple dehydration. […] This distinction can be made easily by urinalysis with microscopy. Notably, myoglobinuria and other factors can cause false-positive chemical tests for hemoglobin, so urine microscopy is required to confirm the diagnosis of hematuria. […] GH also must be distinguished from vaginal bleeding in women, which usually can be achieved by obtaining a careful menstrual history, collecting the specimen when the patient is not having menstrual or gynecologic bleeding, or, if necessary, obtaining a catheterized specimen. […] Hematuria should be differentiated from other conditions which might mimic hematuria such as hemoglobinuria, myoglobinuria, porphyria, bile pigments, and alkaptonuria.

• #70 Blood In Urine (Hematuria): Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15234-hematuria

  A false-positive rate is when the dipstick test says you have blood in your pee, but you dont. Providers need to confirm dipstick hematuria with a microscopic urinalysis. […] Hematuria is common. Medical experts estimate that more than 20% of people who receive an evaluation from a urologist have blood in their pee. Microscopic hematuria affects an estimated 2% to 31% of people. Microscopic hematuria is more common than gross hematuria. […] Having blood in your pee doesnt always mean you have a condition. But it can be an important warning sign that something is wrong with your body. Dont ignore it. Contact a healthcare provider as soon as you find blood in your pee. […] A healthcare provider will review your medical history, ask you questions about any other symptoms and perform a physical examination, which may include a pelvic exam or digital rectal exam. They may also recommend additional tests to help confirm a hematuria diagnosis.

• #71 Hematuria differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hematuria_differential_diagnosis

  Hematuria is usually characterized by red/rusty urine color, positive heme test, red blood cells and casts on microscopy, and normal plasma. […] These characteristic findings might be helpful for differentiation of hematuria from abovementioned conditions. […] Hemoglobinuria is usually characterized by pink/red urine color, positive heme test, no cells on microscopy, and pink plasma. […] Myoglobinuria is usually characterized by rusty urine color, positive heme test, no cells on microscopy (casts might be seen), and normal plasma. […] Porphyria is usually characterized by urine color turns black/brown/red when the urine exposed to sunlight, negative heme test, normal microscopic findings, and normal plasma. […] Bile pigments is usually characterized by brown urine color, negative heme test, normal microscopic findings, and dark to bright yellow (icteric) plasma. […] Alkaptonuria is usually characterized by urine color turns black when the urine exposed to sunlight, negative heme test, normal microscopic findings, and normal plasma.

• #72 Hematuria differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Hematuria_differential_diagnosis

  Hematuria is usually characterized by red/rusty urine color, positive heme test, red blood cells and casts on microscopy, and normal plasma. […] These characteristic findings might be helpful for differentiation of hematuria from abovementioned conditions. […] Hemoglobinuria is usually characterized by pink/red urine color, positive heme test, no cells on microscopy, and pink plasma. […] Myoglobinuria is usually characterized by rusty urine color, positive heme test, no cells on microscopy (casts might be seen), and normal plasma. […] Porphyria is usually characterized by urine color turns black/brown/red when the urine exposed to sunlight, negative heme test, normal microscopic findings, and normal plasma. […] Bile pigments is usually characterized by brown urine color, negative heme test, normal microscopic findings, and dark to bright yellow (icteric) plasma. […] Alkaptonuria is usually characterized by urine color turns black when the urine exposed to sunlight, negative heme test, normal microscopic findings, and normal plasma.

• #73 Hematuria (Blood in the Urine) – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine

  Hematuria means there is blood in your urine. […] Health care professionals use your medical history, a physical exam, and urinalysis to diagnose hematuria and help find the cause. […] Your health care professional will use urinalysis or a urine test to check a sample of your urine for blood. In some cases, your health care professional will test your urine again to confirm the diagnosis of hematuria. […] If urinalysis shows too many red blood cells in your urine, your health care professional may order one or more of the following tests. […] Health care professionals treat hematuria by treating the underlying cause of the hematuria. You may not need treatment if there is no serious condition causing your hematuria. […] Researchers are studying many aspects of hematuria, such as the accuracy of different diagnostic methods to detect bladder cancer in people with hematuria.

• #74 Hematuria (Blood in the Urine) In Adults | National Kidney Foundation

  https://www.kidney.org/kidney-topics/hematuria-blood-urine-adults

  Tests for kidney cancer and other cancers of the urinary tract: Urine cytology: A test that uses a microscope to look for cancer cells in the urine. […] Treatment depends on what is causing the hematuria. Often, no treatment is needed. Infections are treated with antibiotics. If theres a high level of calcium in the urine, eating less salt and drinking more water may help. Sometimes, medication may also help lower calcium levels in the urine. […] If all tests are normal but blood keeps showing up in the urine, yearly checkups are needed to make sure you do not begin to develop kidney disease.

• #75 Assessment of Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0515/p1748.html

  Evaluation of the upper urinary tract followed by cystoscopy fails to identify the source of microscopic hematuria in 19 to 68 percent of patients. […] Findings in support of glomerular etiology include proteinuria (i.e., greater than 300 mg in a 24-hour urine sampling), elevated creatinine levels, red cell casts, or dysmorphic red blood cells. […] Glomerular causes of microscopic hematuria warrant prompt referral to a nephrology subspecialist for further investigation and possible renal biopsy. […] In the event that infection, harmless transient microscopic hematuria, or a glomerular etiology is not identified, patients should receive upper urinary tract imaging, urine cytology, and perhaps cystoscopy. […] The AUA recommends that patients with microscopic hematuria have radiographic assessment of the upper urinary tract followed by urine cytology studies.

• #76 Blood in Urine (Hematuria): Cause, Risk Factors, & Treatment

  https://www.webmd.com/digestive-disorders/blood-in-urine-causes

  Blood in your urine — your doctor might call it hematuria — is a sign that you have something wrong in your urinary tract, maybe something serious. […] You shouldn’t ignore it. Tell your doctor so they can order tests to look for the cause. […] Your doctor will ask about your medical history and send a sample of your pee for lab tests. This is called urinalysis. The tests might include cytology, in which a technician uses a microscope to look for unusual cells, and a urine culture to see if you have an infection. […] Your doctor might order blood tests to look for wastes that your kidneys are supposed to remove. This could be a sign of kidney disease. Blood tests can also spot a problem with your prostate. […] If your doctor cant find a cause for the blood, they might tell you to have follow-up urine tests and blood pressure monitoring every 3 to 6 months, especially if you have risk factors for bladder cancer. […] Hematuria, or blood in your urine, is a sign you have something wrong in your urinary tract. You need to get checked out to find the cause. It’s often the result of an infection, but it can be something more serious. Treatment depends on what’s causing it.

• #77 Hematuria (Blood in the Urine) In Adults | National Kidney Foundation

  https://www.kidney.org/kidney-topics/hematuria-blood-urine

  Hematuria means blood is in the urine. There are many causes in adults, including cancer, infection, and kidney stones. Testing and follow-up are key. […] When the cause is not known and the hematuria is transient (goes away on its own within a short time), there is usually no problem. This is more common with people who are under 35 years of age. But for people who are older than 35, hematuria may be a sign of cancer, even if its transient. […] One or more of these tests may be done for hematuria, depending on your symptoms and the suspected cause. […] Urine tests: Urinalysis (urine test): A test strip is placed in urine and changes color if theres blood. This is just a screening test, so results must be confirmed by looking at the urine with a microscope. […] Treatment depends on what is causing the hematuria. Often, no treatment is needed. Infections are treated with antibiotics. If theres a high level of calcium in the urine, eating less salt and drinking more water may help. Sometimes, medication may also help lower calcium levels in the urine. […] If all tests are normal but blood keeps showing up in the urine, yearly checkups are needed to make sure you do not begin to develop kidney disease.

• #78 Workup of Microscopic Hematuria – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/hematuria

  Significant microscopic hematuria (3 RBC/hpf) should be investigated with renal function testing (urine albumin-to creatinine ratio (ACR), creatinine/eGFR), blood pressure, imaging and possible referral to urology. […] The first line recommended imaging test in most circumstances for the investigation of significant microscopic hematuria is kidney/bladder ultrasound. […] Cystoscopy is recommended for patients with significant microscopic hematuria over the age of 40 or at any age for those with risk factors for urologic malignancy or abnormality on imaging. […] Following a negative workup, urine microscopy, renal function (urine ACR, creatinine/eGFR), blood pressure and urine cytology (if risk factors for urothelial cancer are present) should be followed annually. […] Repeat investigation should be undertaken for gross hematuria, new urinary symptoms, or increasing degree of microscopic hematuria, proteinuria, or declining renal function.

• #79 Workup of Microscopic Hematuria – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/hematuria

  Significant microscopic hematuria (3 RBC/hpf) should be investigated with renal function testing (urine albumin-to creatinine ratio (ACR), creatinine/eGFR), blood pressure, imaging and possible referral to urology. […] The first line recommended imaging test in most circumstances for the investigation of significant microscopic hematuria is kidney/bladder ultrasound. […] Cystoscopy is recommended for patients with significant microscopic hematuria over the age of 40 or at any age for those with risk factors for urologic malignancy or abnormality on imaging. […] Following a negative workup, urine microscopy, renal function (urine ACR, creatinine/eGFR), blood pressure and urine cytology (if risk factors for urothelial cancer are present) should be followed annually. […] Repeat investigation should be undertaken for gross hematuria, new urinary symptoms, or increasing degree of microscopic hematuria, proteinuria, or declining renal function.

• #80 Assessment and management of haematuria in the general practice setting

  https://www1.racgp.org.au/ajgp/2021/july/haematuria-in-the-general-practice-setting

  The presence of haematuria may be a singular symptom signalling underlying urological pathology, either benign or malignant. […] Appropriate early investigation and management of haematuria in the primary care setting is important for timely referral of patients suspected of having serious underlying pathology while avoiding over-investigation in those patients prone to transient and benign causes. […] The approach to the diagnosis and investigation of haematuria differs depending on whether the haematuria is macro- or microscopic. […] Haematuria is one of the most common urological presenting complaints either incidentally or symptomatically detected and is important as it can be a strong indicator of underlying malignancy. […] Previous studies suggest the positive predictive value of haematuria being secondary to an underlying urological malignancy is as high as 11%, highlighting the importance of appropriate primary care work-up and prompt specialist referral where indicated.

• #81 Hematuria – Wikipedia

  https://en.wikipedia.org/wiki/Hematuria

  The first step in evaluation of red or brown colored urine is to confirm true hematuria with urinalysis and urine microscopy, where hematuria is defined by three or more red blood cells per high power field. Although a urine dipstick test may be used, it can give false positive or false negative results. In gathering information, it is important to inquire about recent trauma, urologic procedures, menses, and culture-documented urinary tract infection. If any of these are present, it is appropriate to repeat a urinalysis with urine microscopy in 1 to 2 weeks or after treatment of the infection. If the results of the urinalysis and urine microscopy reveal a glomerular origin of hematuria (indicated by proteinuria or red blood cell casts), consultation with a nephrologist should be made. If the results of the urinalysis indicate a non-glomerular origin, a microbiological culture of the urine should be performed, if it has not been done already. If the culture is positive (indicating a bladder infection), urinalysis and urine microscopy should be repeated following treatment to confirm resolution of the hematuria. If the culture is negative or if hematuria persists after treatment, CT urogram or renal ultrasound and cystoscopy should be performed. Hemodynamic stability should be monitored and a complete blood count should be ordered to assess for anemia.

• #82 Hematuria – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hematuria/

  Identify and manage transient causes (e.g., UTI, nephrolithiasis); reassess for hematuria following treatment. […] Evaluate persistent hematuria based on suspected mechanism (e.g., glomerular vs. nonglomerular hematuria), regardless of whether the patient is receiving antiplatelet or anticoagulant therapy. […] Obtain trauma diagnostics if there are general indications for imaging in genitourinary trauma. […] Repeat the UA before pursuing further diagnostic evaluation if a benign etiology is suspected. […] Initial studies include BMP to evaluate renal function, urine dipstick to detect heme in urine, and urine microscopy to confirm 3 RBCs per HPF and assess for WBCs, bacteria, nitrites, RBC morphology, and protein. […] Dysmorphic RBCs, RBC casts, and/or significant proteinuria on urine microscopy suggest a glomerulopathy. […] Diagnosis of glomerular disease does not rule out urinary tract malignancy. […] Older age, male sex, and smoking are the main risk factors for urinary tract cancer.

• #83 Gross and Microscopic Hematuria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534213/

  The minimum criteria used by the 2020 American Urological Association Microhematuria Guideline to diagnose microhematuria is the unexplained finding in an uncentrifuged specimen on microscopic evaluation of 3 RBC/HPF. […] A microscopic examination of the urinary sediment must always confirm a presumptive diagnosis of microhematuria by dipstick. […] The most severe and devastating consequence of hematuria is malignancy. Many classifications exist to stratify patients into low-, intermediate-, and high-risk; a commonly used and validated system is the 2020 American Urological Association Guideline on Microhematuria Risk Stratification Guide. […] A primary focus of an evaluation of hematuria is to identify and exclude any underlying malignancy; hematuria is the presenting symptom in most bladder cancers. The overall incidence of discovering a genitourinary malignancy in patients with microscopic hematuria is approximately 3%. With gross hematuria, the incidence rises to 10% to 20%.

• #84 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  The presence of microscopic hematuria and dysmorphic red blood cells, cellular casts, proteinuria, elevated creatinine level, or hypertension should raise suspicion for medical renal etiologies, such as immunoglobulin A nephropathy, Alport syndrome, benign familial hematuria, or other nephropathy. […] All patients with confirmed asymptomatic microscopic hematuria should provide a patient history and have a physical examination that includes blood pressure measurement and a laboratory assessment. […] Cystoscopy is recommended in all patients with asymptomatic microscopic hematuria who present with risk factors for malignancy, regardless of age. […] Cystoscopy can identify urethral stricture disease, benign prostatic hyperplasia, and bladder masses. […] If appropriate workup does not reveal nephrologic or urologic disease, then annual urinalysis should be performed for at least two years after initial referral.

• #85 Workup of Microscopic Hematuria – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/hematuria

  Significant microscopic hematuria (3 RBC/hpf) should be investigated with renal function testing (urine albumin-to creatinine ratio (ACR), creatinine/eGFR), blood pressure, imaging and possible referral to urology. […] The first line recommended imaging test in most circumstances for the investigation of significant microscopic hematuria is kidney/bladder ultrasound. […] Cystoscopy is recommended for patients with significant microscopic hematuria over the age of 40 or at any age for those with risk factors for urologic malignancy or abnormality on imaging. […] Following a negative workup, urine microscopy, renal function (urine ACR, creatinine/eGFR), blood pressure and urine cytology (if risk factors for urothelial cancer are present) should be followed annually. […] Repeat investigation should be undertaken for gross hematuria, new urinary symptoms, or increasing degree of microscopic hematuria, proteinuria, or declining renal function.

• #86 Assessment of Asymptomatic Microscopic Hematuria in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1201/p747.html

  The upper urinary tract is best evaluated with multiphasic computed tomography urography, which identifies hydronephrosis, urinary calculi, and renal and ureteral lesions. […] The lower urinary tract is best evaluated with cystoscopy for urethral stricture disease, benign prostatic hyperplasia, and bladder masses. […] Voided urine cytology is no longer recommended as part of the routine evaluation of asymptomatic microscopic hematuria, unless there are risk factors for malignancy. […] In 2012, the American Urological Association (AUA) published an updated guideline on the diagnosis, evaluation, and follow-up of asymptomatic microscopic hematuria in adults. […] Based on the guideline, this article describes the current approaches to diagnosis, follow-up, and referral for patients with asymptomatic microscopic hematuria.

• #87 Workup of Microscopic Hematuria – Province of British Columbia

  https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/hematuria

  Significant microscopic hematuria (3 RBC/hpf) should be investigated with renal function testing (urine albumin-to creatinine ratio (ACR), creatinine/eGFR), blood pressure, imaging and possible referral to urology. […] The first line recommended imaging test in most circumstances for the investigation of significant microscopic hematuria is kidney/bladder ultrasound. […] Cystoscopy is recommended for patients with significant microscopic hematuria over the age of 40 or at any age for those with risk factors for urologic malignancy or abnormality on imaging. […] Following a negative workup, urine microscopy, renal function (urine ACR, creatinine/eGFR), blood pressure and urine cytology (if risk factors for urothelial cancer are present) should be followed annually. […] Repeat investigation should be undertaken for gross hematuria, new urinary symptoms, or increasing degree of microscopic hematuria, proteinuria, or declining renal function.

• #88 Blood in Urine: When to Be Concerned & What to Know

  https://www.cancercenter.com/community/blog/2022/09/when-to-worry-about-blood-in-urine

  But cancer is always a concern with painless, gross hematuria, says Dr. Sadeghi. And thats why it must be properly evaluated. […] Painless, visible blood in the urine requires a urologic evaluation following a two-part process: Imaging, such as a CT scan, that examines the lining of the upper urinary tract and ureters; Cystoscopy, a procedure that uses a scope and a camera to examine the bladder and urethra. […] The No. 1 way bladder cancer is diagnosed is through visible, painless blood in the urine, Dr. Sadeghi says. […] Because of the concern about a possible cancer diagnosis, hematuria, especially the painless kind you can see, must always be taken seriously, Dr. Sadeghi says. […] If you have painless blood in the urine you can see, you must visit a urologist, he says. Theres no way around it. The condition cant be diagnosed by a primary care physician.

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