A Synopsis of AFPs "Practice Guidelines: AUA Guideline Addresses Diagnosis, Evaluation, and Follow-Up of Asymptomatic Microhematuria"

Practice Guidelines: AUA Guideline Addresses Diagnosis, Evaluation, and Follow-Up of Asymptomatic Microhematuria
http://www.aafp.org/afp/2013/0501/p649.pdf
Am Fam Physician. 2013 May 1;87(9):649-653.


     Asymptomatic microhematuria is defined as the presence of 3+ RBC's per HPF. A positive dipstick by itself is not enough to call it asymptomatic microhematuria. Benign causes, such as infection, menstruation, exercise, trauma, or a recent procedure can be ruled out through a proper history and physical. Renal function can be assessed through a GFR, serum creatinine, and BUN. If proteinuria, cellular casts, or dysmorphic RBCs are found, then a further nephrogenic workup is in order.  Patients over 35 years old or those with risk factors (irritation with voiding, smoking, chemical exposure) should undergo a cystoscopy.
     Imaging with a multiphasic CT urography (with or without contrast) is the best choice. Magnetic resonance urography or combining CT with ultrasound can be used if needed. A retrograde pyelogram can be used to evaluate the entire upper tract.  Urine cytology, blue light cytology and urine markers are not recommended routinely. Patients with persistent microhematuria may find cytology helpful after a negative workup, especially if the patient has multiple risk factors. 
     If the workup is negative, but the patient is still having persistent asymptomatic microhematuria, yearly UA can be done. After two negative workups, the evaluation can be repeated after 3-5 years.