• Both microscopic and macroscopic haematuria are abnormal
• Invariably requires investigation
• Population prevalence of macroscopic haematuria is approximately 1%
• Prevalence of microscopic haematuria is about 5%
• 50% of patients with haematuria will have an underlying abnormality
• 10% patients with microscopic haematuria will have a urological malignancy
• 35% patients with macroscopic haematuria will have an underlying tumour

Causes of haematuria

Surgical causes

• Transitional cell carcinoma - bladder, ureter, renal pelvis
• Stone disease
• Renal cell carcinoma
• Trauma
• Benign prostatic hyperplasia
• Urethral stricture

Glomerular medical causes

• IgA nephropathy
• Glomerulonephritis
• Systemic lupus erythematosis
• Bacterial endocarditis

Non-glomerular medical causes

• Urinary tract infections
• Tuberculosis
• Schistosomiasis
• Drugs
• Blood dyscrasias
• Exercise-induced haematuria

Investigation of haematuria

• Investigation should be aimed at excluding a surgical cause
• All patients should undergo
  • Urine microscopy and culture
  • Urine cytology
  • KUB and ultrasound or an IVU
  • Cystoscopy
• If normal then patient should be referred for a nephrological opinion

Bibliography

Cohen R A,  Brown R S.  Microscopic haematuria.  N Engl J Med 2003;  349:  2330-2338

Harper M,  Arya M,  Hamid R,  Patel H R H.  Haematuria:  a stream-lined approach to management.  Hosp Med 2001;  62:  696-698.

Rockall A G, Newman-Sanders A P G, Al-Kutoubi M A, Vale J A. Haematuria. Postgrad Med J 1997; 73: 129-136.