microscopic hematuria
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Introduction
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]
Diagnostic procedures
- 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
More general terms
References
- ↑ 1.0 1.1 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: https://www.ncbi.nlm.nih.gov/pubmed/25148165
- ↑ 2.0 2.1 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 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23098784 (corresponding NGC guideline withdrawn Dec 2017)
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/24364522 Free Article
- ↑ 4.0 4.1 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ 5.0 5.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28418451 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28418525 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2618815 - ↑ 6.0 6.1 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/
- ↑ 7.0 7.1 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: https://www.ncbi.nlm.nih.gov/pubmed/30677457 https://www.goldjournal.net/article/S0090-4295(19)30073-1/fulltext
- ↑ 8.0 8.1 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: https://www.ncbi.nlm.nih.gov/pubmed/31310767 https://www.goldjournal.net/article/S0090-4295(19)30628-4/fulltext
- ↑ 9.0 9.1 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 - ↑ 10.0 10.1 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: https://www.ncbi.nlm.nih.gov/pubmed/32305550 https://www.goldjournal.net/article/S0090-4295(20)30373-3/pdf
- ↑ 11.0 11.1 11.2 Barocas DA, Boorjian SA, Alvarez RD et al Microhematuria: AUA/SUFU Guideline. J Urol. 2020 Oct;204(4):778-786 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32698717
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/23312369 https://www.mayoclinicproceedings.org/article/S0025-6196(12)00990-1/fulltext
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/36400245 https://www.ajkd.org/article/S0272-6386(22)01002-2/fulltext