Asymptomatic Microhematuria
https://www.auanet.org/education/guidelines/asymptomatic-microhematuria.cfm
1. Asymptomatic microhematuria (AMH) is defined as three or greater red blood cells (RBC) per high powered field (HPF) on a properly collected urinary specimen in the absence of an obvious benign cause. A positive dipstick does not define AMH, and evaluation should be based solely on findings from microscopic examination of urinary sediment and not on a dipstick reading. A positive dipstick reading merits microscopic examination to confirm or refute the diagnosis of AMH. Expert Opinion
2. The assessment of the asymptomatic microhematuria patient should include a careful history, physical examination, and laboratory examination to rule out benign causes of AMH such as infection, menstruation, vigorous exercise, medical renal disease, viral illness, trauma, or recent urological procedures. Clinical Principle
3. Once benign causes have been ruled out, the presence of asymptomatic microhematuria should prompt a urologic evaluation. Recommendation (Evidence Strength Grade C)
4. At the initial evaluation, an estimate of renal function should be obtained (may include calculated eGRF, creatinine, and BUN) because intrinsic renal disease may have implications for renal related risk during the evaluation and management of patients with AMH. Clinical Principle
5. The presence of dysmorphic red blood cells, proteinuria, cellular casts, and/or renal insufficiency, or any other clinical indicator suspicious for renal parenchymal disease warrants concurrent nephrologic workup but does not preclude the need for urologic evaluation. Recommendation (Evidence Strength Grade C)
6. Microhematuria that occurs in patients who are taking anti-coagulants requires urologic evaluation and nephrologic evaluation regardless of the type or level of anti-coagulation therapy. Recommendation (Evidence Strength Grade C)
7. For the urologic evaluation of asymptomatic microhematuria, a cystoscopy should be performed on all patients aged 35 years and older. Recommendation (Evidence Strength Grade C)
8. In patients younger than age 35 years, cystoscopy may be performed at the physician's discretion. Option (Evidence Strength Grade C)
9. A cystoscopy should be performed on all patients who present with risk factors for urinary tract malignancies (e.g., irritative voiding symptoms, current or past tobacco use, chemical exposures) regardless of age. Clinical Principle
10. The initial evaluation for AMH should include a radiologic evaluation. Multi-phasic computed tomography (CT) urography (without and with intravenous (IV) contrast), including sufficient phases to evaluate the renal parenchyma to rule out a renal mass and an excretory phase to evaluate the urothelium of the upper tracts, is the imaging procedure of choice because it has the highest sensitivity and specificity for imaging the upper tracts.
https://www.auanet.org/education/guidelines/asymptomatic-microhematuria.cfm
1. Asymptomatic microhematuria (AMH) is defined as three or greater red blood cells (RBC) per high powered field (HPF) on a properly collected urinary specimen in the absence of an obvious benign cause. A positive dipstick does not define AMH, and evaluation should be based solely on findings from microscopic examination of urinary sediment and not on a dipstick reading. A positive dipstick reading merits microscopic examination to confirm or refute the diagnosis of AMH. Expert Opinion
2. The assessment of the asymptomatic microhematuria patient should include a careful history, physical examination, and laboratory examination to rule out benign causes of AMH such as infection, menstruation, vigorous exercise, medical renal disease, viral illness, trauma, or recent urological procedures. Clinical Principle
3. Once benign causes have been ruled out, the presence of asymptomatic microhematuria should prompt a urologic evaluation. Recommendation (Evidence Strength Grade C)
4. At the initial evaluation, an estimate of renal function should be obtained (may include calculated eGRF, creatinine, and BUN) because intrinsic renal disease may have implications for renal related risk during the evaluation and management of patients with AMH. Clinical Principle
5. The presence of dysmorphic red blood cells, proteinuria, cellular casts, and/or renal insufficiency, or any other clinical indicator suspicious for renal parenchymal disease warrants concurrent nephrologic workup but does not preclude the need for urologic evaluation. Recommendation (Evidence Strength Grade C)
6. Microhematuria that occurs in patients who are taking anti-coagulants requires urologic evaluation and nephrologic evaluation regardless of the type or level of anti-coagulation therapy. Recommendation (Evidence Strength Grade C)
7. For the urologic evaluation of asymptomatic microhematuria, a cystoscopy should be performed on all patients aged 35 years and older. Recommendation (Evidence Strength Grade C)
8. In patients younger than age 35 years, cystoscopy may be performed at the physician's discretion. Option (Evidence Strength Grade C)
9. A cystoscopy should be performed on all patients who present with risk factors for urinary tract malignancies (e.g., irritative voiding symptoms, current or past tobacco use, chemical exposures) regardless of age. Clinical Principle
10. The initial evaluation for AMH should include a radiologic evaluation. Multi-phasic computed tomography (CT) urography (without and with intravenous (IV) contrast), including sufficient phases to evaluate the renal parenchyma to rule out a renal mass and an excretory phase to evaluate the urothelium of the upper tracts, is the imaging procedure of choice because it has the highest sensitivity and specificity for imaging the upper tracts.
