- Haematuria is either "microscopic" or "gross".
- It can originate from either the upper urinary tract or the lower tract
- A careful history should be recorded
- Examination should include a careful exam of the external genitalia, abdomen and flanks
- Males also require a rectal exam.
- Urinalysis as well as "culture & sensitivity" should be obtained on all patients with haematuria
- If there is significant proteinuria in addition to blood in the urine, "medical" renal parenchymal disease is likely, and a referral to a nephrologist may be more appropriate
If Microscopic haematuria:
- These patients should undergo further investigation with either an IVP or US as an outpatient
- They should have a urology consult.
- Cystoscopy will likely be done to further delineate the source of bleeding.
- The majority of patients with asymptomatic microscopic haematuria will have no identifiable abnormality, but the work-up is necessary in order to pick up the 5% with serious disease
If clinically well MUH patients should be referred to Fast Track clinic (each Tuesday). Others - refer with letter to their GP who can arrange follow up.