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Microscopic Hematuria (2020 AUA Guidelines): Difference between revisions

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=== History and Physical Exam ===
=== History and Physical Exam ===
* '''History'''
 
** '''Risk factors for malignancy (12):'''
==== History ====
**# '''Age'''
* '''Signs and Symptom'''
**# '''Male sex'''
**'''Degree of hematuria'''
**# '''Smoking'''
** '''Persistence of hematuria'''
**# '''Degree of hematuria'''
** '''History of gross hematuria'''
**# '''Persistence of hematuria'''
** '''Irritative lower urinary tract symptoms'''
**# '''History of gross hematuria'''
*'''Risk factors for malignancy (8):'''
**# '''Irritative lower urinary tract symptoms'''
*# '''Age'''
**# '''Prior pelvic radiation therapy'''
*# '''Male sex'''
**# '''Prior cyclophosphamide/ifosfamide chemotherapy'''
*# '''Smoking'''
**# '''Family history of urothelial cancer or Lynch Syndrome'''
*# '''Prior pelvic radiation therapy'''
**# '''Occupational exposures to benzene chemicals or aromatic amines (e.g., rubber, petrochemicals, dyes)'''
*# '''Prior cyclophosphamide/ifosfamide chemotherapy'''
**# '''Chronic indwelling foreign body in the urinary tract'''
*# '''Family history of urothelial cancer or Lynch Syndrome'''
** '''Medical renal disease'''
*# '''Occupational exposures to benzene chemicals or aromatic amines (e.g., rubber, petrochemicals, dyes)'''
*# '''Chronic indwelling foreign body in the urinary tract'''
* '''Other causes of microscopic hematuria'''
**'''Medical renal disease'''
*** '''Proteinuria, dysmorphic RBCs, cellular casts, or renal insufficiency on urine microscopy may be associated with medical renal disease, which can cause hematuria'''
*** '''Proteinuria, dysmorphic RBCs, cellular casts, or renal insufficiency on urine microscopy may be associated with medical renal disease, which can cause hematuria'''
**** '''If medical renal disease is suspected, refer patients for nephrologic evaluation. However, risk-based urologic evaluation should still be performed.'''
**** '''If medical renal disease is suspected, refer patients for nephrologic evaluation. However, risk-based urologic evaluation should still be performed.'''
** '''Gynecologic and non-malignant genitourinary causes of MH'''
** '''Gynecologic and non-malignant genitourinary causes of MH'''
*** '''Repeat urinalysis following resolution of the gynecologic or non-malignant genitourinary cause.'''
*** '''Repeat urinalysis following resolution of the gynecologic or non-malignant genitourinary cause.'''
**** '''MH may not resolve for several weeks to a few months following treatment of a gynecologic or non-malignant cause of MH, or treatment of a UTI; waiting ≥ 3 weeks after resolution of the non-malignant etiology and ≤ 3 months would be appropriate.'''
**** '''Microscopic hematuria may not resolve for several weeks to a few months following treatment of a gynecologic or non-malignant cause of MH, or treatment of a UTI; waiting ≥ 3 weeks after resolution of the non-malignant etiology and ≤ 3 months would be appropriate.'''
***** '''If MH persists or the etiology cannot be identified, perform risk-based urologic evaluation.'''
***** '''If MH persists or the etiology cannot be identified, perform risk-based urologic evaluation.'''
**** '''Causes of MH that persist and may not require intervention (3):'''
**** '''Causes of MH that persist and may not require intervention (3):'''
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***** In these cases, use careful judgment and shared decision-making to decide whether to pursue MH evaluation. Attention to the patient’s risk factors for urologic malignancy should inform these decisions.
***** In these cases, use careful judgment and shared decision-making to decide whether to pursue MH evaluation. Attention to the patient’s risk factors for urologic malignancy should inform these decisions.
** '''MH in patients who are taking anti-coagulants requires the same evaluation evaluation regardless of the type or level of anti-coagulation therapy'''
** '''MH in patients who are taking anti-coagulants requires the same evaluation evaluation regardless of the type or level of anti-coagulation therapy'''
* '''Physical examination'''
** '''Blood pressure measurement +/- genitourinary examination''', as dictated by the history.
*** In females, examination of the external genitalia, introitus, and periurethral tissue may identify urethral pathology or other gynecologic pathology to explain the MH.


==== '''Physical Examination''' ====
* '''General'''
**'''Blood pressure measurement'''
* '''Genitourinary examination'''
**In females, examination of the external genitalia, introitus, and periurethral tissue may identify urethral pathology or other gynecologic pathology to explain the MH.
=== Laboratory ===
=== Laboratory ===
* '''Serum creatinine and GFR (NOT required in CUA guidelines)'''
* '''Serum creatinine and GFR (NOT required in CUA guidelines)'''
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