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Significant microscopic hematuria was defined as ≥ 3 RBCs/hpf on two microscopic urinalysis without recent exercise, menses, sexual activity or instrumentation

In patients with recent exercise, menses, sexual activity or urethral trauma/instrumentation, a repeat microscopic exam should be done once the contributing factor has ceased. If the subsequent exam is negative, further work-up is not required.
It should be determined if the patient’s hematuria could be secondary to a glomerular cause. The presence of proteinuria, red cell casts, or dysmorphic red blood cells on microscopic exam and/or an elevated creatinine is suggestive of a glomerular cause of hematuria and these patients should be referred to a nephrologist for further investigation.
All other patients should be assessed for the need of further evaluation.

Upper tract imaging is recommended for all patients with microscopic hematuria
IVU, US, and CT are acceptable for the evaluation of the patient with microscopic hematuria.
US is recommended as the first choice for imaging, taking patient safety (ionizing radiation and exposure to i.v. contrast), availability, and cost into consideration. CT and IVU are justified when additional tests are believed to be indicated.

Following a negative evaluation for AMH, 1-3% of patients have been reported to be diagnosed with a urological malignancy within 3 years
Patients should be followed by their primary care physician with urinalysis, urinary cytology, and blood pressure checks at 6, 12, 24 and 36 months

If a patient develops gross hematuria, positive or atypical cytology, or storage irritative voiding symptoms without infection, then repeat urological evaluation is advised.
The development of hypertension, proteinuria, or other findings suggestive the finding of glomerular bleeding would necessitate referral to a nephrologist.
If none of these occur after 3 years, then routine follow-up for persistent hematuria can be ceased