Monitoring of patients with persistent (visible or non visible) haematuria of undetermined aetiology

monitoring of patients with haematuria (visible or non-visible) of undetermined aetiology

• diagnosis after specialist review - relates to cases of persistent haematuria where specialist investigation has not yeilded an aetiology

Primary care monitoring

• annual assessment (whilst haematuria persists) of the following
  • blood pressure
  • estimated glomerular filtration rate (eGFR)
  • albumin creatinine ratio/ protein creatinine ratio (ACR/PCR)
• referral or re-referral to urology if development of visible haematuria (VH) or symptomatic non visible haematuria (s-NVH)
• referral to nephrology if
  • significant or increasing proteinuria (ACR >30 or PCR >50)
  • eGFR <30ml/min (confirmed on at least 2 readings and without an identifiable reversible cause)
  • deteriorating eGFR (by >5ml/min fall within 1 year, or >10ml/min fall within 5 years) (1)

Long term monitoring

Patients not meeting criteria for referral to urology or nephrology, or who have had negative urological or nephrological investigations, need long term monitoring due to the uncertainty of the underlying diagnosis. Patients should be monitored for the development of:

• voiding lower urinary tract symptoms LUTS
• visible haematuria
• significant or increasing proteinuria
• progressive renal impairment (falling eGFR)
• hypertension (noting that the development of hypertension in older people may have no relation to the haematuria and therefore not increase the likelihood of underlying glomerular disease) (1)

Reference:

• (1) Renal Association and British Association of Urological Surgeons (2008). Joint Consensus Statement on the Initial Assessment of Haematuria