Initial assessment

Initial assessment is to find out whether the haematuria is transient or persistent and whether VH (visible haematuria) or NVH (non visible haematuria) is present (1).

If blood is detected in the urine, a detailed history is required in order to find the origin of the haematuria. e.g. -

• any urological symptoms indicating an UTI e.g. fever, frequency dysuria
• symptoms of dysuria, hesitancy and urgency could point towards malignancy
• any history of previous urological problems (e.g. calculi) and medication e.g. anticoagulant therapy.
• their occupation and whether or not they are/have been a smoker or exposed to chemicals (2)

Transient causes of haematuria should be excluded before establishing the presence of significant haematuria:

• urinary tract infection (UTI)
• exercise induced haematuria or rarely myoglobinuria (VH and NVH)
• menstruation (2)

Physical examination is often unhelpful but must be undertaken.

Measurement of blood pressure is important because the combination of microscopic haematuria and hypertension may be indicative of renal disease

Investigations are described in the appropriate section

Consider urgent referral - see menu item

Reference:

• (1) Shields J, Maxwell AP. Evaluating haematuria in primary care. Pulse 2009
• (2) Renal Association and British Association of Urological Surgeons (2008). Joint Consensus Statement on the Initial Assessment of Haematuria