Editing Microscopic Hematuria (2020 AUA Guidelines) (section)

=== Imaging ===
* Goals of upper tract imaging in MH patients (2):
*# Identify malignancies of the renal parenchyma and upper tract urothelium
*# Identify actionable non-malignant diagnoses of the kidney, collecting system, and ureters (e.g. stones)
* CT urography
** Advantages
**# Excellent delineation of the excretory urinary tract
**# Very sensitive for urinary stones
**# Readily identifies renal cortical lesions
**# Provides extra-urinary information as well
** Disadvantages
**# Generally more expensive than renal US
**# Involves ionizing radiation and intravenous contrast
* Renal US
** Advantages
**# Relatively less expensive
**# Does not involve ionizing radiation
**# Reasonable discrimination for cortical lesions
** Disadvantages
**# Image quality is dependent on the operator and the patient’s body habitus
**# Lower sensitivity for urothelial lesions''',''' small solid renal lesions, and kidney stones
* '''Recommended modality based on risk-stratification: (CUA Guidelines recommend US)'''
** '''US for intermediate-risk'''
** '''CT urography for high-risk'''
*** Contraindications to contrast-enhanced CT
**** Chronic kidney disease
**** Allergy to iodine-based contrast
*** If CT contraindicated, consider MR urography; if both CT and MR urography contraindicated, consider retrograde pyelography with non-contrast axial imaging or US
* '''In patients with persistent or recurrent MH previously evaluated with renal US, consider additional imaging of the urinary tract'''
* '''In patients with MH who have a family history of renal cell carcinoma or a known genetic renal tumor syndrome, upper tract imaging should be performed regardless of risk category.'''
* '''For MH during pregnancy, obtain renal US with consideration of multiphasic CT or MR urography after delivery.'''