investigation of haematuria
Last reviewed 01/2018
Preliminary investigations may be undertaken in primary care once transient causes of haematuria are excluded (1). These include:
- urinalysis:
- dipstick testing
- to exclude other causes of a red urine
- dipstick urinalysis for blood is indicated as part of the initial assessment of patients with
- newly detected GFR < 60 ml/min/1.73 m2
- newly discovered proteinuria
- suspected multisystem disease with possible renal involvement (2)
- mid stream urine for:
- microscopy
- the presence of red cells excludes haemoglobinuria
- presence of more than two red cells per high-power field on microscopy is abnormal (although the cut off point varies between ≥2 cells per high power field and≥5 cells per high power field) and requires further investigation
- other findings may suggest infection or renal disease
- culture and sensitivity - guides antibiotic selection if due to infection
- 24-hour urine creatine clearance and urinary protein excretion - this is used to detect mild degrees of renal impairment
- blood tests:
- urea and electrolytes - to assess renal impairment
- full blood count - may require transfusion
- clotting - especially if taking anticoagulants
- imaging investigations include:
- plain film of kidney, ureters and bladder
- intravenous urography
- ultrasound scan - instead of, or in addition to, IVU
Further investigations may include:
- cystoscopy
- imaging
- intravenous urography (IVU)/intravenous pylography (IVP)
- USS
- CT scan
- MRI
- renal biopsy - if histological diagnosis is indicated (4)
Note:
- there is no need in routine clinical practice for confirmation of haematuria by microscopy of a midstream urine sample (3)
Reference:
- (1) Kelly JD, Fawcett DP, Goldberg LC. Assessment and management of non-visible haematuria in primary care. BMJ. 2009;338
- (2) Renal Association and British Association of Urological Surgeons (2008). Joint Consensus Statement on the Initial Assessment of Haematuria
- (3) Rees J, Patel B, Persad R. Asymptomatic dipstick haematuria. Trends in Urology Gynaecology & Sexual Health 2008
- (4) Rodgers M et al. Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation; Health Technology Assessment 2006;10(18)