Haematuria

Question 1

What are some less significant causes of haematuria?

Answer 1

• Urinary tract infection
• Menstruation
• Vigorous exercise (this normally settles after around 3 days)
• Sexual intercourse

Spurious causes - red/orange urine, where blood is not present on dipstick

• foods: beetroot, rhubarb
• drugs: rifampicin, doxorubicin

Question 2

What are some vauses of non-visble haematuria?

Answer 2

• Cancer (bladder, renal, prostate)
• Stones
• Benign prostatic hyperplasia
• Prostatitis
• Urethritis e.g. Chlamydia
• Renal causes: IgA nephropathy, thin basement membrane disease

Question 3

What is the definition of persistent non-visible haematuria?

Answer 3

Blood being present in 2 out of 3 samples tested 2-3 weeks apart

Question 4

What investigations should be done for haematuria?

Answer 4

• Renal function, albumin:creatinine (ACR) or protein:creatinine ratio (PCR) and blood pressure should also be checked
• Urine microscopy may be used but time to analysis significantly affects the number of red blood cells detected

Question 5

When should someone be urgently referred for visible haematuria?

Answer 5

Visible haematuria

• Aged >= 45 years
• Unexplained without urinary tract infection
• Persists or recurs after successful treatment of urinary tract infection

Question 6

When should someone have a non-urgent referral for haematuria?

Answer 6

• Aged >= 60 years with recurrent or persistent unexplained urinary tract infection

Question 7

What patients should be managed in primary care?

Answer 7

Patients < 40 years with normal renal function, no proteinuria and who are normotensive.

Question 8

When should someone be 2WW referred for microscopic haematuria?

Answer 8

Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test