‘ If a patient passes blood, pus or scales in the urine, and if it has a heavy smell, ulceration of the bladder in indicated’ Hippocrates

Approach to Microscopic Hematuria in the Family Practice Dr. Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital

Definition > 3 RBC per high power field 2 –3 properly collected urine sample

> 3 RBC per high power field

2 –3 properly collected urine sample

Incidence Population based studies Aysmtomatic microscopic hematuria 0.19 – 16.1 % incidence Varies according to age, sex of population Asymptomatic Microscopic Hematuria in Adults: Summary of the AUA Best Practice Policy Recommendations 2001

Population based studies

Aysmtomatic microscopic hematuria

0.19 – 16.1 % incidence

Varies according to age, sex of population

Disease commonly associated with microscopic hematuria Renal parenchyma disease Ig A nephropathy Thin glomerular basement membrane nephropathy Urogenital tract disease (50%) Inflammatory – uretheritis, prostatitis, cystitis Stones BPH Malignancies – bladder tumour

Renal parenchyma disease Ig A nephropathy Thin glomerular basement membrane nephropathy

Urogenital tract disease (50%) Inflammatory – uretheritis, prostatitis, cystitis Stones BPH Malignancies – bladder tumour

General Guidelines Routine screening for microscopic hematuria – not recommended Due to lack of specificity, lag time to diagnosis, incidence of serious disease similar to control group All patients with asymptomatic microscopic hematuria should be consider for evaluation

Routine screening for microscopic hematuria – not recommended

Due to lack of specificity, lag time to diagnosis, incidence of serious disease similar to control group

All patients with asymptomatic microscopic hematuria should be consider for evaluation

Normal figures Proteinuria 1+ on dipstick would require further evaluation with 24 Hr UTP > 80% Dysmorphic cells - glomerular disease >80% Isomorphic cells – lower tract pathology

Proteinuria 1+ on dipstick would require further evaluation with 24 Hr UTP

> 80% Dysmorphic cells - glomerular disease >80% Isomorphic cells – lower tract pathology

Follow-up Low risk – consider High risk 6, 12, 24 & 36 months BP UFEME urine cytology (+/-)

Low risk – consider

High risk 6, 12, 24 & 36 months BP UFEME urine cytology (+/-)

Summary Screening not recommended Microscopic hematuria should be evaluated Low risk – upper tract evaluation, cytology High risk – above and cystoscopy; and follow-up at 6, 12, 24 & 36 months if negative

Screening not recommended

Microscopic hematuria should be evaluated

Low risk – upper tract evaluation, cytology

High risk – above and cystoscopy; and follow-up at 6, 12, 24 & 36 months if negative

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