Skip to main content

Hematuria: Evaluation and Management

  • Chapter
  • First Online:
  • 1826 Accesses

Part of the book series: Springer Specialist Surgery Series ((SPECIALIST))

Abstract

Hematuria is the presence of red blood cells in the urine and can be visible to the naked eye (macroscopic), detectable with microscopic analysis or found by dipstick testing of urine. Around 40% of patients with hematuria have a significant underlying cause regardless of the quantity of blood in the urine. As the presence of hematuria is common and there are often no clues as to the underlying cause, this condition comprises a large amount of the urological workload and should be regarded as a manifestation of urological malignancy until proven otherwise.1 While it is recognized that the contemporary urological approach for the investigation of hematuria may not always be evidence-based medicine,1 there are numerous high-quality studies confirming the prevalence of disease within patients with this condition.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Rodgers MA et al. Diagnostic tests used in the investigation of adult haematuria: a systematic review. BJU Int. 2006;98(6):1154-1160

    Article  PubMed  Google Scholar 

  2. Khadra MH et al. A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. J Urol. 2000;163(2):524-527

    Article  PubMed  CAS  Google Scholar 

  3. Nishikawa Y et al. Clinical assessment of patients with microscopic hematuria pointed out by mass screening examination. Hinyokika Kiyo. 1992;38(6):647-651

    PubMed  CAS  Google Scholar 

  4. Grossfeld GD, Carroll PR. Evaluation of asymptomatic microscopic hematuria. Urol Clin North Am. 1998;25(4):661-676

    Article  PubMed  CAS  Google Scholar 

  5. Grossfeld GD et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy–part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology. 2001;57(4):604-610

    Article  PubMed  CAS  Google Scholar 

  6. Grossfeld GD et al. Asymptomatic microscopic hematuria in adults: summary of the AUA best practice policy recommendations. Am Fam Physician. 2001;63(6):1145-1154

    PubMed  CAS  Google Scholar 

  7. Briganti E, McNeil J, Atkins R. The epidemiology of diseases of the kidney and urinary tract: an Australian perspective. Report to the Board of the Australian Kidney Foundation [online]. http://www.med.monash.edu.au/epidemiology/general_info/disease_kidney.html. 2001

  8. Ritchie CD, Bevan EA, Collier SJ. Importance of occult haematuria found at screening. Br Med J (Clin Res Ed). 1986;292(6521):681-683

    Article  CAS  Google Scholar 

  9. Scottish Intercollegiate Guidelines Network. Investigation of asymptomatic microscopic haematuria in adults. www.sign.ac.uk/pdf/sign17.pdf. 1997

  10. McDonald MM, Swagerty D, Wetzel L. Assessment of microscopic hematuria in adults. Am Fam Physician. 2006;73(10):1748-1754

    PubMed  Google Scholar 

  11. Sokolosky MC. Hematuria. Emerg Med Clin North Am. 2001;19(3):621-632

    Article  PubMed  CAS  Google Scholar 

  12. Cohen RA, Brown RS. Clinical practice. Microscopic hematuria. N Engl J Med. 2003;348(23):2330-2338

    Article  PubMed  Google Scholar 

  13. U.S. Preventive Series Task Force. Guide to Clinical Preventive Series. Alexandria, VA: International Medical Publishing; 1996

    Google Scholar 

  14. Sultana SR et al. Microscopic haematuria: urological investigation using a standard protocol. Br J Urol. 1996; 78(5):691-696; discussion 697-698

    PubMed  CAS  Google Scholar 

  15. Benbassat J et al. Symptomless microhaematuria in schoolchildren: causes for variable management strategies. Q J Med. 1996;89(11):845-854

    CAS  Google Scholar 

  16. Renal Association and British Association of Urological Surgeons. Joint consensus statement on the initial assessment of haematuria. 2008

    Google Scholar 

  17. Khan MA, Shaw G, Paris AM. Is microscopic haematuria a urological emergency? BJU Int. 2002;90(4):355-357

    Article  PubMed  CAS  Google Scholar 

  18. Schroeder GL et al. A side by side comparison of cytology and biomarkers for bladder cancer detection. J Urol. 2004;172(3):1123-1126

    Article  PubMed  Google Scholar 

  19. Friedman GD et al. Can hematuria be a predictor as well as a symptom or sign of bladder cancer? Cancer Epidemiol Biomarkers Prev. 1996;5(12):993-996

    PubMed  CAS  Google Scholar 

  20. Mazhari R, Kimmel PL. Hematuria: an algorithmic approach to finding the cause. Cleve Clin J Med. 2002;69(11):870, 872-874, 876 passim

    Google Scholar 

  21. Feld LG et al. Hematuria: an integrated medical and surgical approach. Pediatr Clin N Am. 1997;44(5):1191–1210

    Article  CAS  Google Scholar 

  22. Rockall AG et al. Haematuria. Postgrad Med J. 1997;73(857):129-136

    Article  PubMed  CAS  Google Scholar 

  23. Connelly JE. Microscopic hematuria. In: Black ER, Tape TG, Panzer RJ, eds. Diagnostic Strategies for Common Medical Problems. Philadelphia, PA: American College of Physicians; 1999:518-526

    Google Scholar 

  24. Hiatt RA, Ordonez JD. Dipstick urinalysis screening, asymptomatic microhematuria, and subsequent urological cancers in a population-based sample. Cancer Epidemiol Biomarkers Prev. 1994;3(5):439-443

    PubMed  CAS  Google Scholar 

  25. Budman LI, Kassouf W, Steinberg JR. Biomarkers for detection and surveillance of bladder cancer. Can Urol Assoc J. 2008;2(3):212-221

    PubMed  Google Scholar 

  26. Pode D et al. Noninvasive detection of bladder cancer with the BTA stat test. J Urol. 1999;161(2):443-446

    Article  PubMed  CAS  Google Scholar 

  27. Nasuti JF et al. Utility of the BTA stat test kit for bladder cancer screening. Diagn Cytopathol. 1999;21(1):27-29.

    Article  PubMed  CAS  Google Scholar 

  28. Walsh IK et al. The BTA stat test: a tumor marker for the detection of upper tract transitional cell carcinoma. Urology. 2001;58(4):532-535

    Article  PubMed  CAS  Google Scholar 

  29. Chahal R et al. Evaluation of the clinical value of urinary NMP22 as a marker in the screening and surveillance of transitional cell carcinoma of the urinary bladder. Eur Urol. 2001;40(4):415-420; discussion 421

    Article  PubMed  CAS  Google Scholar 

  30. Ponsky LE et al. Screening and monitoring for bladder cancer: refining the use of NMP22. J Urol. 2001;166(1):75-78

    Article  PubMed  CAS  Google Scholar 

  31. Zippe C, Pandrangi L, Agarwal A. NMP22 is a sensitive, cost-effective test in patients at risk for bladder cancer. J Urol. 1999;161(1):62-65

    Article  PubMed  CAS  Google Scholar 

  32. Akaza H et al. Evaluation of urinary NMP22 (nuclear matrix protein 22) as a diagnostic marker for urothelial cancer – screening for urothelial cancer in patients with microscopic hematuria. NMP Study Group. Gan To Kagaku Ryoho. 1997;24(7):837-842

    PubMed  CAS  Google Scholar 

  33. Miyanaga N et al. Urinary nuclear matrix protein 22 as a new marker for the screening of urothelial cancer in patients with microscopic hematuria. Int J Urol. 1999;6(4):173-177

    Article  PubMed  CAS  Google Scholar 

  34. Miyoshi Y, Matsuzaki J, Miura T. Evaluation of usefulness of urinary nuclear matrix protein 22 (NMP22) in the detection of urothelial transitional cell carcinoma. Hinyokika Kiyo. 2001;47(6):379-383

    PubMed  CAS  Google Scholar 

  35. Oge O et al. Evaluation of nuclear matrix protein 22 (NMP22) as a tumor marker in the detection of bladder cancer. Int Urol Nephrol. 2001;32(3):367-370

    Article  PubMed  CAS  Google Scholar 

  36. Paoluzzi M et al. Urinary dosage of nuclear matrix protein 22 (NMP22) like biologic marker of transitional cell carcinoma (TCC): a study on patients with hematuria. Arch Ital Urol Androl. 1999;71(1):13-18

    PubMed  CAS  Google Scholar 

  37. Vasanthakumar V et al. A study to assess the efficacy of chemoprophylaxis in the prevention of endoscopy-related bacteraemia in patients aged 60 and over. Q J Med. 1990;75(278):647-653

    PubMed  CAS  Google Scholar 

  38. Koss LG et al. Diagnostic value of cytology of voided urine. Acta Cytol. 1985;29(5):810–816

    PubMed  CAS  Google Scholar 

  39. Jaffe JS et al. A new diagnostic algorithm for the evaluation of microscopic hematuria. Urology. 2001;57(5):889-894

    Article  PubMed  CAS  Google Scholar 

  40. Jamis-Dow CA et al. Small (< or = 3-cm) renal masses: detection with CT versus US and pathologic correlation. Radiology. 1996;198(3):785-788

    PubMed  CAS  Google Scholar 

  41. Sutton JM. Evaluation of hematuria in adults. J Am Med Assoc. 1990;263(18):2475-2480

    Article  CAS  Google Scholar 

  42. Gray Sears CL et al. Prospective comparison of computerized tomography and excretory urography in the initial evaluation of asymptomatic microhematuria. J Urol. 2002;168(6):2457-2460

    Article  PubMed  Google Scholar 

  43. Sourtzis S et al. Radiologic investigation of renal colic: unenhanced helical CT compared with excretory urography. Am J Roentgenol. 1999;172(6):1491-1494

    CAS  Google Scholar 

  44. Luchs JS et al. Utility of hematuria testing in patients with suspected renal colic: correlation with unenhanced helical CT results. Urology. 2002;59(6):839-842

    Article  PubMed  Google Scholar 

  45. Igarashi T et al. Clinical and radiological aspects of infiltrating transitional cell carcinoma of the kidney. Urol Int. 1994;52(4):181-184

    Article  PubMed  CAS  Google Scholar 

  46. Buckley JA et al. Transitional cell carcinoma of the renal pelvis: a retrospective look at CT staging with pathologic correlation. Radiology. 1996;201(1):194-198

    PubMed  CAS  Google Scholar 

  47. Carson CC III, Segura JW, Greene LF. Clinical importance of microhematuria. J Am Med Assoc. 1979;241(2):149-150

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer London

About this chapter

Cite this chapter

Bryant, R.J., Catto, J.W.F. (2011). Hematuria: Evaluation and Management. In: Chapple, C., Steers, W. (eds) Practical Urology: Essential Principles and Practice. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84882-034-0_26

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-034-0_26

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-033-3

  • Online ISBN: 978-1-84882-034-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics