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JAMA Clinical Guidelines Synopsis |

Evaluation of Patients With Asymptomatic Microhematuria

David Kiragu, MD1; Adam S. Cifu, MD2
[+] Author Affiliations
1Wilson Medical Group, Wilson, North Carolina
2Department of Medicine, University of Chicago, Chicago, Illinois
JAMA. 2015;314(17):1865-1866. doi:10.1001/jama.2015.13711.
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This JAMA Clinical Guidelines Synopsis summarizes the American Urological Association’s 2012 guideline for evaluating patients with asymptomatic microhematuria.

Box Section Ref ID

Guideline title Evaluation of Patients With Asymptomatic Microhematuria

Developer American Urological Association (AUA)

Release date October 23, 2012

Prior version May 15, 2001

Funding source AUA

Target population Adults with asymptomatic microhematuria

Major recommendations

  1. Definition: Asymptomatic microhematuria (AMH) is defined as 3 or more red blood cells per high-powered field in a properly collected urine specimen. A positive dipstick reading alone is not considered AMH (expert opinion).

  2. Evaluation: After benign causes (eg, infection, menstruation, vigorous exercise) are excluded, evaluation should include assessment of renal function (clinical principle), complete urinalysis (grade C recommendation), and evaluation of the entire urinary tract. Lower urinary tract: cystoscopy should be performed in patients aged 35 years or older (grade C) and in all patients with risk factors for urinary tract malignancies (clinical principle). Risk factors include irritative voiding symptoms (urinary urgency, urge incontinence frequency, and nocturia) and current or past tobacco use, history of bladder irradiation, and chemical exposures (dyes, benzenes, aromatic amines, and alkylating chemotherapy agents). Upper urinary tract: computed tomography (CT) with and without intravenous (IV) contrast (CT urography) is the imaging mode of choice (grade C). For patients with contraindications to CT urography, magnetic resonance imaging (MRI) urography without and with IV contrast is an acceptable alternative (grade C). For patients with contraindications to both CT and MRI, combining noncontrast CT or renal ultrasound with retrograde pyelograms is an alternative for evaluating the upper urinary tract (expert opinion).

  3. Follow-up: In patients with persistent microhematuria despite a negative workup or who have other risk factors, urine cytology may be useful (grade C). For persistent AMH after a negative urological workup, yearly urinalyses should be conducted (grade C); if negative for 2 consecutive years, no further urinalyses for AMH are necessary (expert opinion). For persistent or recurrent AMH after initial negative urologic workup, consider repeat evaluation within 3 to 5 years (expert opinion).

  4. Special circumstances: At initial evaluation, findings suspicious for renal parenchymal disease (eg, dysmorphic red blood cells, red blood cell casts, proteinuria, cellular casts) warrant concurrent nephrologic evaluation but do not preclude the need for a urologic evaluation. Asymptomatic microhematuria warrants the same management regardless of anticoagulation status (grade C).

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