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Investigation of haematuria

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:


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