How Can We Help?
Haematuria
When the condition is accompanied by other symptoms, these usually help guide investigation, but in truly asymptomatic haematuria, it is worth having a broad idea of likely pathologies:
- Glomerular disease (IgA nephropathy, mesangioproliferative GN, and thin membrane nephropathy) accounts for between 40 and 50%
- Urethritis and prostatitis (cause about 10%).
- Depending on the series, urothelial malignancies account for another 5-10%.
- Most other causes account for less than 1% each.1 In individuals under the age of 40, up to 50% of cases may be unexplained, and urothelial malignancies are rare.
- An occasional shortcut on history may occur if there is a clear story of traditional medicine treatment for impotence. Such therapies often contain crushed beetles (cantharidins).
Investigations:
- Take a careful history (consider bilharzia) and examine properly (including prostate examination in males!)
- Check with urine microscopy that there really is haematuria (and not haemoglobinuria).
- Look for schistosoma eggs yourself, but also send a specimen off to the laboratory if the patient has been in a bilharzia-endemic area.
- Look for casts – if present, the cause is likely to be renal – investigate as a glomerulonephritis.
- Urine for cytology (main value in those over the age of 40) is insensitive on its own (sens 44%) and should not be used to rule out bladder cancer2
- Ultrasound of kidneys and bladder.
- Cystoscopy.
- Consider IVP – the yield from this procedure, particularly in young patients in whom no abnormalities have been found with the previous set of investigations, is quite low. Always make sure that the patient is not in renal failure or dehydrated before embarking on this procedure.
Rockall AG, Newman-Sanders AP, Al-Kutoubi MA et al. Haematuria. Postgrad Med J. 1997 ↩
Tan WS, Sarpong R, Khetrapal P, Rodney S, Mostafid H, Cresswell J, Watson D, Rane A, Hicks J, Hellawell G, Davies M, Srirangam SJ, Dawson L, Payne D, Williams N, Brew-Graves C, Feber A, Kelly JD; DETECT I trial collaborators. Does urinary cytology have a role in haematuria investigations? BJU Int. 2019 Jan;123(1):74-81. doi: 10.1111/bju.14459. Epub 2018 Aug 29. PMID: 30003675; PMCID: PMC6334509. ↩