Haematuria

The management of patients with haematuria is often difficult due to the absence of widely followed guidelines. It is sometimes unclear whether patients are best managed in primary care, by urologists or by nephrologists.

The terminology surrounding haematuria is changing. Microscopic or dipstick positive haematuria is increasingly termed non-visible haematuria whilst macroscopic haematuria is termed visible haematuria. Non-visible haematuria is found in around 2.5% of the population.

Causes of transient or spurious non-visible haematuria

• urinary tract infection
• menstruation
• vigorous exercise (this normally settles after around 3 days)
• sexual intercourse

Causes of persistent non-visible haematuria

• cancer (bladder, renal, prostate)
• stones
• benign prostatic hyperplasia
• prostatitis
• urethritis e.g. Chlamydia
• renal causes: IgA nephropathy, thin basement membrane disease

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

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

Management

Current evidence does not support screening for haematuria. The incidence of non-visible haematuria is similar in patients taking aspirin/warfarin to the general population hence these patients should also be investigated.