Microscopic Haematuria

Advice: The following patients need referral for further investigation:

  • symptomatic microscopic haematuria (any age)
  • asymptomatic microscopic haematuria aged more than 40 yr

Refer To: Urologist.

Note: Visible (macroscopic) haematuria (any age) needs urgent investigation by an urologist.

Definition of 'significant' microscopic haematuria

What is clinically significant microscopic haematuria

Transient causes need to be excluded before diagnosing significant haematuria

What about anticoagulants?

Initial investigations to consider

When to consider referral to nephrology




Definition of 'significant' microscopic haematuria

  • 1+ or greater on urine dipstick
  • Trace haematuria should be considered negative.

Urine dipstick of a fresh voided MSU, containing no preservative, is adequate for detecting microscopic haematuria.

Routine MC&S is not necessary for confirmation of microscopic haematuria.

What is clinically significant microscopic haematuria

  • A single episode of symptomatic microscopic haematuria (in absence of UTI or other transient causes).
  • Persistent asymptomatic microscopic haematuria (in absence of UTI or other transient causes). Persistence is defined as 2 out of 3 dipsticks positive.

Transient causes need to be excluded before diagnosing significant haematuria

  • Menstruation
  • UTI
    (Following treatment, a dipstick should be repeated to confirm absence of haematuria)
  • Exercise induced haematuria

What about anticoagulants?

Haematuria should be investigated irrespective of anticoagulant/antiplatelet therapy.

Initial investigations to consider

  • Exclude UTI or other transient cause of microhaematuria
  • Creatinine / eGFR
  • Measure proteinuria on a random sample.
    Protein:creatinine ratio or albumin:creatinine ratio can be performed
    (24-hour urine collections for protein are rarely required)
  • Blood pressure

When to consider referral to nephrology

  • Evidence of declining GFR (by >10ml/min in the last five years or by >5ml/min within the last year)
  • eGFR <30ml/min)
  • Significant proteinuria (Alb:Cr ≥30mg/mmol or Protein:Cr ≥50mg/mmol)
  • Isolated microscopic haematuria (no proteinuria) with hypertension in those aged <40

(These guidelines have been adapted from the Joint Consensus Statement on the Initial Assessment of Haematuria, by the Renal Association and British Association of Urological Surgeons)

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