Microscopic hematuria

Reported prevalence rate of 13-20%.

Refers to three or more red blood cells per high-powered field in a properly collected urine specimen.

A positive dipstick reading is not considered a symptomatic microscopic hematuria.

After benign causes such as infection, menstruation, vigorous exercise, are excluded evaluation includes renal function, complete urinalysis, evaluation of the entire urinary tract.

Cystoscopy should be performed in patients 35 years of age or older and in all patients with the risk factors for urinary tract malignancies.

Risk factors include irritative voiding symptoms, of urgency, urge incontinence and frequency.

Urinary tract tumors is it found in 3% of patients presenting with asymptomatic microscopic hematuria.

In patients with persistent microscopic hematuria despite a negative work up or who have other risk factors urine cytology may be useful diagnostic test.

Yearly urinalysis should be conducted in patients for persistent asymptomatic microscopic hematuria after a negative urologic work up.

With persistent or recurrent asymptomatic microscopic hematuria after initial negative urologic work for 2 years, a repeat evaluation should occur within 3 to 5 years.

At initial evaluation, finding suspicious for renal parenchyma disease such as red blood cell casts, proteinuria, dysmorphic red blood cells, concurrent nephrologic evaluation should be done.

Upper urinary tract evaluation with CT scan with and without IV contrast is the imaging mode of choice.

In patients with contraindications to CT urography MRI urography without and with contrast is an acceptable alternative.

In patients who cannot have CT or MRI renal ultrasound with retrograde pyelogram is an alternative to evaluate the upper urinary tract.

Evaluation of asymptomatic microscopic hematuria can provide early diagnosis of urinary tract malignancies and improve outcomes for patients.

4% of evaluations for asymptomatic microscopic hematuria yield a diagnosis of malignancy.

Diagnoses made during the work up of asymptomatic microscopic hematuria include nephrolithiasis and BPH.

Potential damage associated with urologic work up including radiation exposure, allergic contrast reactions, and contrast nephropathy.


Evaluation guidelines suggest cystoscopy and radiologic imaging as evaluation of choice. 


Approximately 1% of patients with asymptomatic microscopic hematuria with negative findings initially develop important disease doing 14 years of follow-up.

Greater than 90% of cancer diagnoses associated with microscopic hematuria occur among patients age 35 years or older.


Urine cytology is generally an unreliable test in the evaluation of microscopic hematuria with the specificity of 62.5 to 100%.

Patients with asymptomatic microscopic hematuria should have a valuation regardless of anticoagulation status.

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