Management of Patients with Microhematuria: AUA/SUFU guidelines

The prevalence of microhematuria among healthy patients ranges from 2.4% to 31.1%.1 Although 13.1% of gross hematuria episodes are associated with malignancy, only 0.3% to 6.3% of microhematuria episodes are associated with malignancy.

Characteristics of guidelines score:

The AUA and SUFU developed this guideline with representation from the American College of Obstetricians and Gynaecologists and a patient advocate.

Panellists disclosed conflicts of interest and were disqualified if conflicts compromised objectivity.

Some major recommendations of the latest guidelines were:

Microhematuria should be considered to be more than 3 blood cells per high power field on microscopic evaluation of a urine specimen.

Patients with microhematuria attributed to a gynaecologic or diagnosed urologic etiology, such as urinary tract infection should have repeated urinalysis after resolution of the causative condition.

Clinicians should refer patients with microhematuria and suspected kidney disease to a nephrologist. This should not preclude a risk-based urologic evaluation.

Clinicians should categorize patients with microhematuria as at low, intermediate, and high risk of genitourinary malignancy based on risk factors.

Low-risk patients should engage in shared decision making about repeat urinalysis within 6 months or cystoscopy and kidney ultrasound. Intermediate risk patients should undergo cystoscopy and kidney ultrasound. High-risk patients should undergo cystoscopy and axial upper tract imaging.

Patients whose evaluation for microhematuria is unrevealing may have to repeat urinalysis within 12 months. Patients with persistent or recurrent microhematuria should engage in shared decision making for additional microhematuria evaluation. If subsequent urinalysis for microhematuria is negative, further evaluation may be discontinued.

Reference:

Management of Patients with Microhematuria by Judge C et. al published in the JAMA.

doi:10.1001/jama.2021.4770