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.

• • Initial hematuria: Indicate urethral pathology

1. 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.