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Hematuria
Diagnosis/Definition
- Any episode of hematuria.
- 3 RBC/HPF on at least 2 out of 3 properly collected and properly performed urinalyses or a single episode of high grade > 100 RBC/HPF. Each test should be separated by at least 2 weeks.
Initial Diagnosis and Management
- Initial diagnosis is by microscopic examination of a properly collected urinalysis.
- Proper collection is defined as a mid stream specimen in a patient who has avoided strenuous physical exercise or instrumentation for at least 48hrs. Women should not be menstruating.
- Chemical evaluation of hematuria (dipstick Urinalysis) correlates poorly with quantitative evaluations of formed elements (RBC/HPF) and can detect hematuria down to physiologic normal limits.
- A properly performed urinalysis is one that has been performed by a standardized technique that gives reproducible results.
- rine should be sent for culture and sensitivity and the patient treated if there is evidence of infection.
- Serum Chem 7 should be obtained to assess kidney function.
- Pregnancy test should be obtained in all females of childbearing potential.
- The referring physician should obtain a “CT Hematuria” protocol CT scan. If allergic to contrast consider renal ultrasound or renal MRI prior to referral.
Ongoing Management and Objectives
- Patients with a single abnormal UA with less then 100RBC/HPF should be rechecked in six weeks.
- Patients with evidence of urinary tract infection as the cause of the hematuria should be treated appropriately and rechecked for microscopic hematuria in six weeks.
- Patients with a recent history of trauma or strenuous physical exercise should be rechecked for microscopic hematuria in a similar time frame (6 weeks).
Indications for Specialty Care Referral
Any patient with gross hematuria.
Those patients with microscopic hematuria as defined above with no evidence of infection.
Criteria for Return to Primary Care
A patient who has a negative anatomic evaluation as performed by the Urology Service. Hematuria is likely to persist in the majority of patients who are followed-up after the initial evaluation.
All patients should be checked for microscopic hematuria after return to primary care with urinalysis yearly.
Patients require a reevaluation if microscopic hematuria persists every 3 years or if gross hematuria recurs at any time or if they develop irritative voiding symptoms.
