Evaluation of Hematuria in Adults

James M. Sutton, MD
JAMA. 1990;263(18):2475-2480. doi:10.1001/jama.1990.03440180081037.
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GROSS hematuria (GH) or microscopic hematuria (MH) may be a clue to serious urologic disease, including malignancy. However, there is no consensus concerning either the level of MH to evaluate or the extent of the evaluation.1-5 In recent series, 39% to 90% of those with MH on screening urinalysis were not tested further.3-5 In those who were evaluated, an intravenous pyelogram (IVP) and cystoscopy were commonly not performed. With these points in mind, I will review the subject of hematuria in adults.

DEFINITION AND DEMOGRAPHICS OF MH  The marked variations in the reported upper limit of normal for urinary red blood cells (RBCs) in subjects without apparent renal disease are primarily due to the different methods of quantification (Table 1) and to the lack of control of activities just prior to urine collection that may induce transient MH (eg, mild trauma, exercise, viral illness, sexual activity, or digital


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