HAEMATURIA WORKUP
Microscopic Haematuria
Microscopic Haematuria (defined as >3RBC/HPF ie. blood in the urine that cannot be seen) should be evaluated with history and physical examination to identify precipitating factors (infection, menstruation, renal stones or recent urological procedures) and risk factors (smoking, previous exposure to chemicals). If proteinuria is present or red cell morphology is concerning the patient should also receive concurrent nephrology consultation.
Dr Paffen recommends the following investigations to work-up microscopic haematuria to screen for a malignant cause (ie: bladder, urethra, upper tract carcinomas or locally advanced prostate cancer):
- Urine cytology x3 (ie. on 3 separate consecutive days, not first morning sample)
- Urine MCS
- CT Urogram if patient is >45yrs. An ultrasound KUB is sufficient in low risk individuals or patients with renal failure (eGFR <40).
- PSA (in men)
If any of the above tests are concerning or patient has risk factors for bladder or upper tract carcinomas (ie: smoker, personal or family history, occupational exposure to paints/dyes or rubbers), Dr Paffen will arrange for a Cystoscopy.
Gross or Macroscopic Haematuria
Macroscopic haematuria (bleeding that can be seen) is much more concerning for a malignant cause (a significant abnormality is found in around 20% of people).
Dr Paffen recommends the following investigations to work-up macroscopic haematuria:
- Urine cytology x3 (ie. on 3 separate consecutive days, not first morning sample)
- Urine MCS
- CT Urogram if patient is >45yrs. An ultrasound KUB is sufficient in low risk individuals or patients with renal failure (eGFR <40).
- PSA (in men)
Dr Paffen will arrange for a Cystoscopy.