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| __NOTOC__
| | == History and Symptoms == |
| http://www.jurology.com/article/S0022-5347(12)04958-0/pdf
| | {|style="width:80%; height:100px" border="1" |
| | | |style="height:100px"; style="width:15%" border="1" | '''CATEGORY''' |
| == Definition == | | |style="height:100px"; style="width:15%" border="1" | '''EXAMPLES''' |
| Microscopic hematuria is defined as the presence of three or greater red blood cells per high powered
| | |style="height:100px"; style="width:70%" border="1" | '''COMMON CLINICAL PRESENTATION AND RISK FACTORS''' |
| field on a properly collected urinary specimen in the absence of an obvious benign cause.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref>
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| == Causes == | |
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| === Overview ===
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| The causes of MH are either urologic or nephrologic. The most common urological etiologies are [[BPH|benign prostatic enlargement]], infection and [[urinary calculi]].
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| === Common Causes === | |
| {| class="wikitable"
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| |- | | |- |
| ! style="width: 40%;" | Common Causes of Glomerular Hematuria
| | |style="height:100px"; style="width:15%" border="1" | Neoplasm |
| ! colspan="2" style="width: 60%;" | Common Causes of Non-Glomerular Hematuria
| | |style="height:100px"; style="width:15%" border="1" | Any |
| | |style="height:100px"; style="width:70%" border="1" | Male gender, Age older than 35 years, Past or current smoking history, Occupational or other exposure to chemicals or dyes (benzenes or aromatic amines), Analgesic abuse, History of gross hematuria, History of urologic disorder or disease, History of Irritative voiding symptoms, History of pelvic irradiation, History of chronic urinary tract infection, Exposure to known carcinogenic agents or chemotherapy such as alkylating agents, History of chronic indwelling foreign body |
| |- | | |- |
| | valign = top | | | | '''Chemical / poisoning''' |
| * IgA nephropathy (Berger's disease)
| | |bgcolor="Beige"| [[Alcohol withdrawal]], [[Aluminum ]], [[Carbon monoxide poisoning]], [[Ifosamide]], [[Lead poisoning]], [[Methylene Chloride ]], [[Narcotics]], [[Occupational lead exposure ]], [[Toxic mushrooms]] |
| * Thin glomerular basement membrane disease
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| * Hereditary nephritis (Alport's syndrome)
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| | valign = top |
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| '''Upper urinary tract'''<br> | |
| *Urolithiasis
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| *Pyelonephritis
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| *Renal cell cancer
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| *Transitional cell carcinoma
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| *Urinary obstruction
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| *Benign hematuria
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| <br>
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| |'''Lower urinary Tract''' <br> | |
| *Bacterial cystitis (UTI)
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| *Benign prostatic hyperplasia
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| *Strenuous exercise ("marathon runner's hematuria")
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| *Transitional cell carcinoma
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| *Spurious hematuria (e.g. menses)
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| *Instrumentation
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| *Benign hematuria (e.g. interstitial cystitis, trigonitis)
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| |} | |
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| == Prevalence ==
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| The prevalence of microscopic hematuria ranges from 1-20% depending on the population studied. The likelihood of finding significant urologic disease in these patients also varies with associated risk factors which include:
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| * Older age
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| * Male gender
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| * History of cigarette smoking
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| * History of chemical exposure (cyclophosphamide, benzenes, aromatic amines)
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| * History of pelvic radiation
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| * Irritative voiding symptoms (urgency, frequency, dysuria)
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| * Prior urologic disease or treatment
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| The prevalence of microscopic hematuria varies depending on age, gender, frequency of testing, threshold used to define MH and presence of risk factors such as smoking.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref>
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| Asymptomatic microscopic hematuria in the general population is common. The prevalence of some degree of hematuria has been reported to be as high as 9% to 18% in large screening studies.<ref name="pmid23312369">Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G et al. (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23312369 Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria.] ''Mayo Clin Proc'' 88 (2):129-38. [http://dx.doi.org/10.1016/j.mayocp.2012.10.004 DOI:10.1016/j.mayocp.2012.10.004] PMID: [https://pubmed.gov/23312369 23312369]</ref>
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| The prevalence of MH may be higher in women because of benign conditions but the prevalence of urological cancers in women is low ( e.g. In women risk of bladder cancer is 3- to 4-fold lower, and risk of renal cancer is 2-fold lower, compared with men)<ref name="pmid27751797">Lippmann QK, Slezak JM, Menefee SA, Ng CK, Whitcomb EL, Loo RK (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=27751797 Evaluation of microscopic hematuria and risk of urologic cancer in female patients.] ''Am J Obstet Gynecol'' ():. [http://dx.doi.org/10.1016/j.ajog.2016.10.008 DOI:10.1016/j.ajog.2016.10.008] PMID: [https://pubmed.gov/27751797 27751797]</ref>
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| == Diagnosis ==
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| A positive dipstick does not define MH, 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 MH.Patients who have a positive dipstick test but a negative specimen on microscopy should have three additional repeat tests. If at least one of the repeat tests is positive on microscopy, then work-up should be undertaken. If all three specimens are negative on microscopy, then the patient may be released from care.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref>
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| <br>'''Evaluation of Microscopic Hematuria Algorithm'''<ref name="pmid24364522">Sharp VJ, Barnes KT, Erickson BA (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=24364522 Assessment of asymptomatic microscopic hematuria in adults.] ''Am Fam Physician'' 88 (11):747-54. PMID: [https://pubmed.gov/24364522 24364522]</ref><ref name="CohenBrown2003">{{cite journal|last1=Cohen|first1=Robert A.|last2=Brown|first2=Robert S.|title=Microscopic Hematuria|journal=New England Journal of Medicine|volume=348|issue=23|year=2003|pages=2330–2338|issn=0028-4793|doi=10.1056/NEJMcp012694}}</ref>
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| [[Image:Evaluation of Microscopic Hematuria Algorithm.jpg]] | |
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| <br>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.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref>
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| American Urological Association (AUA) best practice policy recommendations include urine testing (urine culture or urine cytologic testing), imaging (multiphase abdominal computed tomography [CT] or intravenous pyelography plus renal ultrasonography), and cystoscopy.<ref name="pmid23312369">Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G et al. (2013) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23312369 Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria.] ''Mayo Clin Proc'' 88 (2):129-38. [http://dx.doi.org/10.1016/j.mayocp.2012.10.004 DOI:10.1016/j.mayocp.2012.10.004] PMID: [https://pubmed.gov/23312369 23312369]</ref>
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| Because MH has been associated with underlying urologic cancer, the AUA recommends evaluation with cystoscopy and upper tract imaging, preferably with computer tomography (CT) scan, for all patients >35 years of age with this finding.
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| == References ==
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