From the Guidelines
The workup for 3+ hematuria should begin with a thorough history and physical examination, followed by laboratory and imaging studies, as recommended by the American College of Physicians 1. The initial evaluation should include a complete urinalysis with microscopic examination to confirm the presence of red blood cells and assess for other abnormalities like proteinuria, pyuria, or casts.
- A urine culture should be obtained to rule out infection.
- Blood tests should include complete blood count, comprehensive metabolic panel, and coagulation studies to evaluate kidney function and rule out bleeding disorders. Imaging studies typically start with a renal ultrasound to assess for kidney stones, masses, or structural abnormalities.
- Depending on initial findings, a CT urogram may be necessary to better visualize the entire urinary tract. For patients over 35 years old or those with risk factors for malignancy (smoking history, chemical exposures, prior pelvic radiation), cystoscopy should be performed to directly visualize the bladder and rule out bladder cancer 1. If glomerular disease is suspected based on the presence of dysmorphic red blood cells, red cell casts, or significant proteinuria, nephrology consultation and possible kidney biopsy may be warranted. This comprehensive approach is necessary because hematuria can indicate serious underlying conditions including malignancy, kidney disease, or urinary tract stones, and prompt diagnosis is essential for appropriate treatment, as emphasized by the American College of Physicians 1.
From the Research
Workup for 3+ Hematuria
The workup for 3+ hematuria involves a comprehensive approach to determine the underlying cause of the condition.
- A thorough history and physical examination are essential to assess potential causes and risk factors for malignancy 2.
- Laboratory tests, such as urinalysis and blood work, may be ordered to rule out intrinsic renal disease and other potential causes 2, 3.
- Imaging studies, including ultrasound, CT scan, or MRI, may be used to evaluate the urinary tract and detect any abnormalities 3, 4.
- A cystoscopic evaluation of the lower urinary system may also be necessary to rule out urologic malignancy or other conditions 3.
Potential Causes of Hematuria
The potential causes of hematuria are diverse and may include:
- Urinary tract infections 2, 3, 5
- Urolithiasis (kidney stones) 2, 3, 5
- Benign prostatic hyperplasia (enlarged prostate) 2, 3
- Urologic malignancy (cancer) 2, 3, 4
- Trauma 5
- Certain medications, such as ciprofloxacin 6
Referral to Specialists
Referral to specialists, such as urologists and nephrologists, may be necessary to further evaluate and manage the condition 2, 3, 4.