Haematuria - ADULTS

Haematuria can either be

  • visible haematuria (VH) –  macroscopic haematuria or gross haemtauria
  • non visible haematuria (NVH) –  microscopic haematuria or ‘dipstick positive haematuria’

What if they are on anticoagulants or antiplatelet therapy?

  • You should not assume the haematuria is because of anti-coagulant or anti-platelet therapy
  • Patients should be evaluated regardless of these medications.

Investigations:

  • Dipstick – any proteinuria as well?
  • MSSU for MC&S – guides antibiotic selection if UTI 
  • 24h urine creatine clearance & urinary protein excretion – re: is there renal impairment?
  • Bloods – U&E (for renal function), FBC (if any anaemia), clotting screen
  • KUB x-ray vs IVU vs USS

Management: NICE says…

urgent 2ww suspected cancer referral if…

  • aged 45 and over and have:
      1. unexplained visible haematuria (i.e. no UTI)
      2. visible haematuria that persists or recurs after successful treatment of urinary tract infection
  • aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test
  • consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection (i.e. suspected bladder cancer)
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