Context

Fig.1 Sample of urine with hematuria via Wikimedia Commons

Haematuria is the presence of red cells in urine. It is abnormal and always requires further investigation. It may be macroscopic (visible to the naked eye) or microscopic (when 3-5 red blood cells per high power field are seen). Both are commonly encountered in the emergency department [1].

Health screening programmes have found haematuria to be present in 2-4% of men and 8-11% of women [4]. Microscopic haematuria is most often an incidental finding, but may be associated with malignancy in up to 10% of cases [2]. Somewhat worryingly, studies have shown that 39% of patients with microscopic haematuria on screening analysis do not receive correct follow up testing [14]. Malignancy has been reported in up to 34% of cases of macroscopic haematuria [2].

Learning bite

Haematuria is considered urinary tract malignancy until proven otherwise. All patients with haematuria need rapid follow up and should be referred to 2 week wait urology clinics. Gross hematuria more often indicates a lower tract cause, whereas microscopic hematuria tends to occur with kidney disease.