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Hematuria

Tracy O. Middleton, DO, FACOFP Reviewed 06/2019
 


BASICS

DESCRIPTION

Gross (visible) or microscopic (nonvisible) blood in the urine, either symptomatic or asymptomatic 

EPIDEMIOLOGY

Prevalence

  • Children: gross: 0.13%; asymptomatic microscopic hematuria (A...

DIAGNOSIS

HISTORY

Considerations 
  • Burning, urgency, frequency: UTI

  • Dark cola-colored urine: glomerular origin

  • Clots: extraglomerular bleeding

  • Arthritis/arthralgias/rash: lupus, vasculitis, Henoch-Schönlein...

TREATMENT

MEDICATION

None indicated for undiagnosed hematuria 

ISSUES FOR REFERRAL

  • Nephrology referral for proteinuria, red cell casts, elevated serum creatinine, and albumin:creatinine ratio ≥30 mg/mmol...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Some experts still recommend periodic urinalysis; recent literature suggests that, after thorough initial negative investigations (imaging, cyst...

REFERENCES

1
Linder BJ, Bass EJ, Mostafid H, et al. Guideline of guidelines: asymptomatic microscopic haematuria. BJU Int.  2018;121(2):176–183. [View Abstract on OvidMedline]
2
Davis R, Jones JS, B...

ADDITIONAL READING

  • DeGeorge KC, Holt HR, Hodges SC. Bladder cancer: diagnosis and treatment. Am Fam Physician.  2017;96(8):507–514. [View Abstract on OvidMedline]

  • Tan WS, Sarpong R, Khetrapal P, e...

CODES

ICD10

  • R31.9 Hematuria, unspecified

  • R31.1 Benign essential microscopic hematuria

  • R31.0 Gross hematuria

  • R31.2 Other microscopic hematuria

  • N02.9 Recurrent and perst hematuria w unsp morphologic changes

  • N...

CLINICAL PEARLS

  • Screening asymptomatic patients for microscopic hematuria is an “I” recommendation from the USPSTF.

  • AMH and hematuria persisting after treatment of UTIs must be evaluated.

  • Patients with ...

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