Microscopic Haematuria

Transient Causes

• Transient– UTI – Exercise

• Spurious– Menstrual contamination– Sexual intercourse

Causes continued

Urological:• BPH• Bladder, kidney,

prostate, ureteric cancer

• Renal stones • Prostatitis• Radiation cystitis• TB

Renal• IgA nephropathy • Glomerulonephritis• Vasculitis

When to Investigate

• Don’t opportunistically check urine

• Only if clinical indication

• Urine dip 1+ blood is positive

• If symptomatic needs investigation

• If asymptomatic- blood persistent on 2 out of 3 samples

Investigations

• BP

• UE

• ACR

• If > 40 yrs – urology assessment, imaging and cystoscopy

• If < 40 years and all normal- monitor

• If < 40 and any abnormality- renal rv

Monitoring

• Annual BP, UE and ACR

• Refer if visible haematuria or symptomatic to urology

• Refer to renal if increasing proteinuria, GFR < 30 or deteriorating GFR

Case

• 55 year old male

• Seen 2 weeks ago with fever, urine dip at the time, negative for infection, 1+ blood

• Has brought 2 further samples over the last 2 weeks, both are 1+ of blood on dipstick

• Fever has resolved and he is now well in his self

• You feel he needs referral to investigate further

Summary

• Common

• Diagnosed on dipstick

• Check BP, UE, ACR

• Under 40 think renal

• Over 40 think urological