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microscopic hematuria

see hematuria Laboratory: - see hematuria - urinalysis - repeat urinalysis in 6 months in low-risk patients [11] - urine color: yellow - urine microscopy - RBC casts & proteinuria suggest glomerulonephritis - pyuria suggests UTI - repeat microscopic hematuria - urine dipstick - detects > 5 RBC/hpf - detects hemoglobin & myoglobin - false positives - ascorbate > 5 mg/dL - contamination with povidone-iodine - insufficient for diagnosis of microscopic hematuria [9] - urine cytology or markers should not be used routinely [6] Special laboratory: - combination of cystoscopy & renal ultrasound is the most cost effective diagnostic approach [5,8] - combination of cystoscopy & CT urography in high-risk patients [11] Radiology: - CT urography no better than unenhanced computed tomography in patients < 50 years of age [1] Complications: - bladder cancer - 0.8% in women, 1.9% in men - no patient < 50 years with bladder cancer on cystoscopy [7] - no asymptomatic patients with low risk score had cancer [10] - chronic kidney disease (RR=5%) Management: - see hematuria - monitoring of renal function, including estimates of GFR & proteinuria/albuminuria because renal failure may occur later in life [2,4] Notes: - Snomed term

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hematuria

References

  1. Lisanti CJ et al. CT evaluation of the upper urinary tract in adults younger than 50 years with asymptomatic microscopic hematuria: Is IV contrast enhancement needed? AJR Am J Roentgenol 2014 PMID: 25148165
  2. Davis R, Jones JS, Barocas DA et al Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012 Dec;188(6 Suppl):2473-81. PMID: 23098784 (corresponding NGC guideline withdrawn Dec 2017)
  3. Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. Am Fam Physician. 2013 Dec 1;88(11):747-54. Review. PMID: 24364522 Free Article
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  5. Halpern JA, Chughtai B, Ghomrawi H. Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria. JAMA Intern Med. Published online April 17, 2017 PMID: 28418451 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2618818 - Subak LL, Grady D Asymptomatic Microscopic Hematuria - Rethinking the Diagnostic Algorithm. JAMA Intern Med. Published online April 17, 2017 PMID: 28418525 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2618815
  6. American Urological Association Fifteen Things Physicians and Patients Should Question Released February 21, 2013 (1-5), June 11, 2015 (6-10), May 13, 2017 (11-15); sources for #5 revised May 9, 2016 http://www.choosingwisely.org/societies/american-urological-association/
  7. Gonzalez AN, Lipsky MJ, Li G et al. The prevalence of bladder cancer during cystoscopy for asymptomatic microscopic hematuria. Urology 2019 Apr; 126:34 PMID: 30677457 https://www.goldjournal.net/article/S0090-4295(19)30073-1/fulltext
  8. Smith MR, Read KC, Stegman ML et al. Evaluation of asymptomatic microscopic hematuria by renal ultrasound to detect upper tract malignancy: A 20-year experience in a community hospital. Urology 2019 Nov; 133:34 PMID: 31310767 https://www.goldjournal.net/article/S0090-4295(19)30628-4/fulltext
  9. Bankhead C Guideline Clarifies Work-up for Microhematuria - Positive dipstick test alone insufficient for diagnosis. MedPage Today July 1, 2020 https://www.medpagetoday.com/meetingcoverage/aua/87364 - Barocas D et al Microhematuria: AUA/SUFU guideline. American Urological Society. 2020 May. https://www.auanet.org/guidelines/microhematuria
  10. Rabinowitz DE, Wood AM, Marziliano A et al. Use of a risk stratification tool to guide evaluation of patients with asymptomatic microscopic hematuria. Urology. 2020 Jul;141:27.e1-27.e6 PMID: 32305550 https://www.goldjournal.net/article/S0090-4295(20)30373-3/pdf
  11. Barocas DA, Boorjian SA, Alvarez RD et al Microhematuria: AUA/SUFU Guideline. J Urol. 2020 Oct;204(4):778-786 PMID: 32698717
  12. Loo RK, Lieberman SF, Slezak JM et al Stratifying Risk of Urinary Tract Malignant Tumors in Patients With Asymptomatic Microscopic Hematuria. Mayo Clinic Proceedings 2013. 88(2):129-138 PMID: 23312369 https://www.mayoclinicproceedings.org/article/S0025-6196(12)00990-1/fulltext
  13. Um YJ et al. Risk of CKD following detection of microscopic hematuria: A retrospective cohort study. Am J Kidney Dis 2023 Apr; 81:425. PMID: 36400245 https://www.ajkd.org/article/S0272-6386(22)01002-2/fulltext