Sandbox:Hematuria overview

Hematuria is the presence of blood cells in the urine. Gross hematuria is when blood is visible in the urine. Microscopic hematuria is defined as 3 or more red blood cells per high-powered field in a properly collected urine sample.

Haematuria is the presence of blood in the urine and is a common condition in urological practice. It accounts for around 20% of urological referrals and is important, as it can be a cardinal symptom of urological malignancy. Around 40% of patients investigated for haematuria are found to have significant underling pathology, half of whom will have a urological malignancy. Therefore, all patients presenting with a single episode of haematuria require urgent investigation. Haematuria in adults should be regarded as a symptom of urological malignancy until proven otherwise.

Classification

Classification by the extent of hematuria

1. Dipstick hematuria:
2. Microscopic hematuria: Microscopic haematuria is more than two to five red blood cells per high-powered field within macroscopically normal urine.
3. Macroscopic hematuria:

Classification by the visibility of hematuria

1. Visible hematuria: Visible haematuria can be visualized with the naked eye and is also known as frank, gross or macroscopic haematuria. Visible haematuria is more likely to be associated with malignancy.
   1. Initial hematuria: Indicate urethral pathology
2. Non-visible hematuria: Non-visible haematuria encompasses dipstick and microscopic haematuria.

1. Microscopic hematuria: Defined as the presence of three or greater red blood cells per high powered field on a properly collected urinary specimen in the absence of an obvious benign cause.

1. Transient hematuria: A single urinalysis with hematuria is common and can result from menstruation, viral illness, allergy, exercise, or mild trauma.
2. Persistant or Significant hematuria: >3 RBCs/HPF on three urinalyses, a single urinalysis with >100 RBCs, or gross hematuria.

Age:

Young patients are more likely to have intrinsic renal pathology (i.e. glomerulonephritis whereas malignancy is more common in the elderly).

Sex:

Malignancy of the bladder and kidney is at least twice as common in males than in females. Women are more commonly affected by urinary tract infections.