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May 9, 1990, Vol 263, No. 18 >
ARTICLE | May 9, 1990

Evaluation of Hematuria in Adults FREE

James M. Sutton, MD
[+] Author Affiliations

Reprint requests to Division of Nephrology, Arnett Clinic, 2600 Greenbush St, Lafayette, IN 47904 (Dr Sutton).


JAMA. 1990;263(18):2475-2480. doi:10.1001/jama.1990.03440180081037
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Published online
Article
References

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

REFERENCES

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Glassock RJ.  Hematuria and pigmenturia . In: Massry SG, Glassock RJ, eds. Textbook of Nephrology . Baltimore, Md: Williams & Wilkins; 1989;:491-495.
2 +
Abuelo JG.  The diagnosis of hematuria . Arch Intern Med. 1983;;143:967-971.
3 +
Fraser CG, Smith BC, Peake MJ.  Effectiveness of an outpatient urine screening program . Clin Chem. 1977;;23:2216-2218.
4 +
Ritchie CD, Bevan EA, Collier SJ.  Importance of occult hematuria found at screening . BMJ. 1986;;292:681-683.
5 +
Mohr DN, Offord KP, Owen RA, Melton LJ.  Asymptomatic microhematuria and urologic disease: a population based study . JAMA. 1986;; 256:224-229.
6 +
Addis T.  The number of formed elements in the urinary sediment of normal individuals . J Clin Invest. 1926;;2:409-415.
7 +
Gadeholt H.  Quantitative estimation of cells in urine . Acta Med Scand. 1968;;183:369-374.
8 +
Gyory AZ, Kesson AM, Talbot JM.  Microscopy of urine—now you see it, now you don't . Am Heart J. 1980;;99:537-538.
9 +
Birch DF, Fairley KF, Whitworth JA, et al.  Urinary erythrocyte morphology in the diagnosis of glomerular hematuria . Clin Nephrol. 1983;;20: 78-85.
10 +
Wright WT.  Cell counts in urine . Arch Intern Med. 1959;;103:76-78.
11 +
Sanders C.  Clinical urine examination and the incidence of microscopic hematuria in apparently normal males . Practitioner . 1963;:191:192-198.
12 +
Larcom RC, Carter GH.  Erythrocytes in urinary sediment: identification and normal limits . J Lab Clin Med. 1948;;33:875-880.
13 +
Alwall N, Lohi A.  A population study on renal and urinary tract diseases . Acta Med Scand. 1973;;194:529-535.
14 +
Froom P, Gross M, Ribak J, Barzilay J, Benbassat J.  The effect of age on the prevalence of asymptomatic microscopic hematuria . Am J Clin Pathol. 1986;;86:656-657.
15 +
Froom P, Gross M, Froom J, Margaliot S, Benbassat J.  Sensitivity of the high power field method in detecting red blood cells in the urinary sediment . Isr J Med Sci. 1987;;23:1118-1120.
16 +
Fassett RG, Horgan BA, Mathew TH.  Detection of glomerular bleeding by phase-contrast microscopy . Lancet. 1982;;1:1432-1434.
17 +
Woolhandler S, Pels RJ, Bor DH, Himmelstein DU, Lawrence RS.  Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders . JAMA. 1989;;262:1215-1219.
18 +
Arm JP, Peile EB, Rainford DJ, Strike PW, Tettmar RE.  Significance of dipstick hematuria: part 1 . Br J Urol. 1986;;58:211-217.
19 +
Vallancien G, Cadranel J, Jardin A.  What should be done in the presence of isolated microscopic hematuria in the workplace? Presse Med. 1985;;14:1279-1281.
20 +
Mariani AJ, Luangphinith S, Loo S, Scottolini A, Hodges CV.  Dipstick chemical analysis: an accurate, cost-effective, screening test . J Urol. 1984;;132:64-66.
21 +
Vaughan ED, Wyker AW.  Effect of osmolality on the evaluation of microscopic hematuria . J Urol. 1971;;105:709-713.
22 +
Messing EM, Young TB, Hunt VB, Emoto SE, Wehbie JM.  The significance of asymptomatic microhematuria in men over 50 years old: findings of a home screening study using urinary dipsticks . J Urol. 1987;;137:919-921.
23 +
Britton JP, Dowell AC, Whelan P.  Dipstick haematuria and bladder cancer in men over 60: results of a community study . BMJ. 1989;;299:1010-1012.
24 +
Relling MV, Schunk JE.  Drug-induced hemorrhagic cystitis . Clin Pharm. 1986;;5:590-597.
25 +
Kraus SE, Siroky MB, Babayan RK, Krane RJ.  Hematuria and the use of nonsteroidal anti-inflammatory drugs . J Urol. 1984;;132:288-290.
26 +
Antolak SJ, Mellinger GT.  Urologic evaluation of hematuria occurring during anticoagulant therapy . J Urol. 1969;;101:111-113.
27 +
Benton O, Lazarchick J, Orak JK, Turner WR.  Use of the bleeding time determination in the evaluation of unexplained hematuria . J Urol. 1987;; 137:527-528.
28 +
Stapleton FB, Roy S, Noe HN, Jerkins G.  Hypercalciuria in children with hematuria . N Engl J Med. 1984;;310:1345-1348.
29 +
Blumenthal SS, Fritsche C, Lemann J.  Establishing the diagnosis of benign familial hematuria: the importance of examining the urinary sediment of family members . JAMA. 1988;;259:2263-2266.
30 +
Oksenhelder E, Bourbigot B, Desbazeille F, et al.  Recurrent hematuria in four white patients with sickle cell trait . J Urol. 1984;;132:1201-1203.
31 +
Schwab TR, Donadio JV.  Serology and renal disease: a review . Semin Nephrol. 1985;;5:179-187.
32 +
Benson GS, Brewer ED.  Hematuria: algorithm for diagnosis . JAMA. 1981;;246:993-995.
33 +
Tapp DC, Copley JB.  The effect of red blood cell lysis on protein quantification in hematuric states . Am J Nephrol. 1988;;8:190-193.
34 +
O'Neill WM, Wallin JD, Walker PD.  Hematuria and red blood cell casts in typical diabetic nephropathy . Am J Med. 1983;;74:389-395.
35 +
Schumann GB, Harris S, Henry JB.  An improved technique of examining urinary casts and a review of their significance . Am J Clin Pathol. 1978;;69:18-23.
36 +
Fassett RG, Owen JE, Fairley J, Birch DF, Fairley KF.  Urinary red cell morphology during exercise . BMJ. 1982;;285:1455-1457.
37 +
Linder LE, Vacca D, Haber MH.  Identification and composition of types of granular urinary casts . Am J Clin Pathol. 1983;;80:353-358.
38 +
De Santo NG, Nuzzi F, Capodicasa G, et al.  Phase contrast microscopy of urine sediment for the diagnosis of glomerular and nonglomerular bleeding—data in children and adults with normal creatinine clearances . Nephron. 1987;;45:35-39.
39 +
Abdurrahman MB, Kambal AM, Kurbaan KM, Imambaccus MY, Chagla AH.  Diagnostic value of phase contrast microscopy in haematuria . Trop Geogr Med. 1985;;37:171-176.
40 +
Rizzoni G, Braggion F, Zacchello G.  Evaluation of glomerular and nonglomerular hematuria by phase contrast microscopy . J Pediatr. 1983;;103: 370-374.
41 +
Raman GV, Pead L, Lee HA, Maskell R.  A blind, controlled trial of phase microscopy by 2 observers for evaluating the source of hematuria . Nephron. 1986;;44:304-308.
42 +
Pillsworth TJ, Haver VM, Abrass CK, Delaney CJ.  Differentiation of renal from non renal hematuria by microscopic examination of erythrocytes in urine . Clin Chem. 1987;;33:1791-1795.
43 +
Pollock C, Pei-Ling L, Gyory AZ, et al.  Dysmorphism of urinary red blood cells—value in diagnosis . Kidney Int. 1989;;36:1045-1049.
44 +
Schramek P, Schuster FX, Georgopoulos M, Porpaczy P, Maier M.  Value of urinary erythrocyte morphology assessment in symptomless microhematuria . Lancet. 1989;;2:1316-1319.
45 +
Shichiri M, Nishio Y, Suenaga M, et al.  Red cell volume distribution curves in diagnosis of glomerular and non glomerular hematuria . Lancet. 1988;;1:908-911.
46 +
Banks RA, Reynolds S, Hanbury D.  Identification of the source of hematuria by automated measurement of red cell volume . Br J Urol. 1989;;64: 45-48.
47 +
Docci D, Delvecchio C, Turci F, Turci A, Baldrati L, Martinelli A.  Detection of glomerular bleeding by urinary red cell size distribution . Nephron. 1988;;50:380-382.
48 +
Tsukahara H, Yoshimoto M, Morikawa K, Okada T, Kuroda M, Sudo M.  Urinary erythrocyte volume analysis: a simple method for detecting the site of hematuria in pediatric patients . J Pediatr. 1989;;115:433-436.
49 +
DeCaestecker MP, Hall CL, Basterfield PT, Smith JG.  Localization of haematuria by red cell analyzers and phase microscopy . Nephron. 1989;;52:170-173.
50 +
Gothlin JH, Gadeholt G, Hoiem L, Aslaksen A.  Changing scene of urology: value of urography as initial examination in infectious and hypertensive disease, hematuria, and malignant disease . Eur J Radiol. 1988;;8:135-139.
51 +
Dana A, Michel JR, Jungers P, Silbert-Zbili A, Droz D, Moreau JF.  Diagnostic etiologique des hematuries microscopiques . Nouv Presse Med. 1981;;10:963-966.
52 +
Jonsson K, Owman T.  Roentgenologic aspects of hematuria . Scand J Urol Nephrol. 1976;;10:229-234.
53 +
Barkin M, Lopatin W, Herschorn S, Comisarow R.  Unexplained hematuria . Can J Surg. 1983;;26:501-503.
54 +
Corwin HL, Silverstein MD.  The diagnosis of neoplasia in patients with asymptomatic microscopic hematuria: a decision analysis . J Urol. 1988;;139:1002-1006.
55 +
Warshauer DM, McCarthy SM, Street L, et al.  Detection of renal masses: sensitivities and specificities of execretory urography/linear tomography, US, and CT . Radiology . 1988;;169:363-365.
56 +
Clayman RV, Vilanur S, Miller RP, Reinke DB, Fraley EE.  Pursuit of the renal mass . Am J Med. 1984;;77:218-222.
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Corrie D, Thompson IM.  The value of retrograde pyelography for fractionally visualized upper tracts on IVP in the evaluation of hematuria . J Urol. 1987;;138:554-556.
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Jones DJ, Langstaff RJ, Holt SD, Morgans BT.  The value of cystourethroscopy in the investigation of microscopic hematuria in adult males under 40 years . Br J Urol. 1988;;62:541-545.
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Bard RH.  The significance of asymptomatic microscopic hematuria in women and its economic implications . Arch Intern Med. 1988;;148:2629-2632.
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Davides KC, King LM, Jacobs D.  Management of microscopic hematuria: 20 year experience with 150 cases in a community hospital . Urology . 1986;;28:453-455.
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Froom P, Ribak J, Benbassat J.  Significance of microhematuria in young adults . BMJ. 1984;; 288:20-22.
85 +
Thompson IM.  The evaluation of microscopic hematuria: a population-based study . J Urol. 1987;; 138:1189-1190.
86 +
Mohr DN, Offord KP, Melton LJ.  Isolated asymptomatic microhematuria: a cross sectional analysis of test positive and test negative patients . J Gen Intern Med. 1987;;2:318-324.
87 +
Mariani AJ, Mariani MC, Macchioni C, Stams UK, Hariharan A, Moriera A.  The significance of adult hematuria: 1000 hematuria evaluations including a risk benefit and cost effectiveness analysis . J Urol. 1989;;141:350-355.
88 +
Lee LW, Davis E.  Gross urinary hemorrhage: a symptom not a disease . JAMA. 1933;;153:782-783.
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Carter WC, Rouss SN.  Gross hematuria in 110 adult urologic hospital patients . Urology . 1981;; 18:342-344.
90 +
Gillatt DA, O'Reilly PH.  Hematuria analyzed: a prospective study . J R Soc Med. 1987;;80:559-560.
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Strom J.  Cellular elements in the urine in health and in acute infectious diseases, especially with respect to the presence of hematuria . Scand J Infect Dis. 1975;;7:97-102.
92 +
Smith MC, Cooke JH, Zimmerman DM, et al.  Asymptomatic glomerulonephritis after nonstreptococcal upper respiratory infections . Ann Intern Med. 1979;;91:697-702.
93 +
Kincaid-Smith P.  Hematuria and exercise related hematuria . BMJ. 1982;;285:1595-1596.
94 +
LeRoy JB.  Banana-seat hematuria . N Engl J Med. 1973;;287:311.
95 +
Froom P, Gross M, Froom J, Caine Y, Margaliot S, Bebassat J.  Factors associated with microhematuria in asymptomatic young men . Clin Chem. 1986;;32:2013-2015.
96 +
Ammann P, Rossi E.  Allergic hematuria . Arch Dis Child. 1966;;41:539-541.
97 +
Vehaskari VM, Rapola J, Koskimies O, Savilahti E, Vilska J, Hallman N.  Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation . J Pediatr. 1979;;95:676-683.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Glassock RJ.  Hematuria and pigmenturia . In: Massry SG, Glassock RJ, eds. Textbook of Nephrology . Baltimore, Md: Williams & Wilkins; 1989;:491-495.
2 +
Abuelo JG.  The diagnosis of hematuria . Arch Intern Med. 1983;;143:967-971.
3 +
Fraser CG, Smith BC, Peake MJ.  Effectiveness of an outpatient urine screening program . Clin Chem. 1977;;23:2216-2218.
4 +
Ritchie CD, Bevan EA, Collier SJ.  Importance of occult hematuria found at screening . BMJ. 1986;;292:681-683.
5 +
Mohr DN, Offord KP, Owen RA, Melton LJ.  Asymptomatic microhematuria and urologic disease: a population based study . JAMA. 1986;; 256:224-229.
6 +
Addis T.  The number of formed elements in the urinary sediment of normal individuals . J Clin Invest. 1926;;2:409-415.
7 +
Gadeholt H.  Quantitative estimation of cells in urine . Acta Med Scand. 1968;;183:369-374.
8 +
Gyory AZ, Kesson AM, Talbot JM.  Microscopy of urine—now you see it, now you don't . Am Heart J. 1980;;99:537-538.
9 +
Birch DF, Fairley KF, Whitworth JA, et al.  Urinary erythrocyte morphology in the diagnosis of glomerular hematuria . Clin Nephrol. 1983;;20: 78-85.
10 +
Wright WT.  Cell counts in urine . Arch Intern Med. 1959;;103:76-78.
11 +
Sanders C.  Clinical urine examination and the incidence of microscopic hematuria in apparently normal males . Practitioner . 1963;:191:192-198.
12 +
Larcom RC, Carter GH.  Erythrocytes in urinary sediment: identification and normal limits . J Lab Clin Med. 1948;;33:875-880.
13 +
Alwall N, Lohi A.  A population study on renal and urinary tract diseases . Acta Med Scand. 1973;;194:529-535.
14 +
Froom P, Gross M, Ribak J, Barzilay J, Benbassat J.  The effect of age on the prevalence of asymptomatic microscopic hematuria . Am J Clin Pathol. 1986;;86:656-657.
15 +
Froom P, Gross M, Froom J, Margaliot S, Benbassat J.  Sensitivity of the high power field method in detecting red blood cells in the urinary sediment . Isr J Med Sci. 1987;;23:1118-1120.
16 +
Fassett RG, Horgan BA, Mathew TH.  Detection of glomerular bleeding by phase-contrast microscopy . Lancet. 1982;;1:1432-1434.
17 +
Woolhandler S, Pels RJ, Bor DH, Himmelstein DU, Lawrence RS.  Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders . JAMA. 1989;;262:1215-1219.
18 +
Arm JP, Peile EB, Rainford DJ, Strike PW, Tettmar RE.  Significance of dipstick hematuria: part 1 . Br J Urol. 1986;;58:211-217.
19 +
Vallancien G, Cadranel J, Jardin A.  What should be done in the presence of isolated microscopic hematuria in the workplace? Presse Med. 1985;;14:1279-1281.
20 +
Mariani AJ, Luangphinith S, Loo S, Scottolini A, Hodges CV.  Dipstick chemical analysis: an accurate, cost-effective, screening test . J Urol. 1984;;132:64-66.
21 +
Vaughan ED, Wyker AW.  Effect of osmolality on the evaluation of microscopic hematuria . J Urol. 1971;;105:709-713.
22 +
Messing EM, Young TB, Hunt VB, Emoto SE, Wehbie JM.  The significance of asymptomatic microhematuria in men over 50 years old: findings of a home screening study using urinary dipsticks . J Urol. 1987;;137:919-921.
23 +
Britton JP, Dowell AC, Whelan P.  Dipstick haematuria and bladder cancer in men over 60: results of a community study . BMJ. 1989;;299:1010-1012.
24 +
Relling MV, Schunk JE.  Drug-induced hemorrhagic cystitis . Clin Pharm. 1986;;5:590-597.
25 +
Kraus SE, Siroky MB, Babayan RK, Krane RJ.  Hematuria and the use of nonsteroidal anti-inflammatory drugs . J Urol. 1984;;132:288-290.
26 +
Antolak SJ, Mellinger GT.  Urologic evaluation of hematuria occurring during anticoagulant therapy . J Urol. 1969;;101:111-113.
27 +
Benton O, Lazarchick J, Orak JK, Turner WR.  Use of the bleeding time determination in the evaluation of unexplained hematuria . J Urol. 1987;; 137:527-528.
28 +
Stapleton FB, Roy S, Noe HN, Jerkins G.  Hypercalciuria in children with hematuria . N Engl J Med. 1984;;310:1345-1348.
29 +
Blumenthal SS, Fritsche C, Lemann J.  Establishing the diagnosis of benign familial hematuria: the importance of examining the urinary sediment of family members . JAMA. 1988;;259:2263-2266.
30 +
Oksenhelder E, Bourbigot B, Desbazeille F, et al.  Recurrent hematuria in four white patients with sickle cell trait . J Urol. 1984;;132:1201-1203.
31 +
Schwab TR, Donadio JV.  Serology and renal disease: a review . Semin Nephrol. 1985;;5:179-187.
32 +
Benson GS, Brewer ED.  Hematuria: algorithm for diagnosis . JAMA. 1981;;246:993-995.
33 +
Tapp DC, Copley JB.  The effect of red blood cell lysis on protein quantification in hematuric states . Am J Nephrol. 1988;;8:190-193.
34 +
O'Neill WM, Wallin JD, Walker PD.  Hematuria and red blood cell casts in typical diabetic nephropathy . Am J Med. 1983;;74:389-395.
35 +
Schumann GB, Harris S, Henry JB.  An improved technique of examining urinary casts and a review of their significance . Am J Clin Pathol. 1978;;69:18-23.
36 +
Fassett RG, Owen JE, Fairley J, Birch DF, Fairley KF.  Urinary red cell morphology during exercise . BMJ. 1982;;285:1455-1457.
37 +
Linder LE, Vacca D, Haber MH.  Identification and composition of types of granular urinary casts . Am J Clin Pathol. 1983;;80:353-358.
38 +
De Santo NG, Nuzzi F, Capodicasa G, et al.  Phase contrast microscopy of urine sediment for the diagnosis of glomerular and nonglomerular bleeding—data in children and adults with normal creatinine clearances . Nephron. 1987;;45:35-39.
39 +
Abdurrahman MB, Kambal AM, Kurbaan KM, Imambaccus MY, Chagla AH.  Diagnostic value of phase contrast microscopy in haematuria . Trop Geogr Med. 1985;;37:171-176.
40 +
Rizzoni G, Braggion F, Zacchello G.  Evaluation of glomerular and nonglomerular hematuria by phase contrast microscopy . J Pediatr. 1983;;103: 370-374.
41 +
Raman GV, Pead L, Lee HA, Maskell R.  A blind, controlled trial of phase microscopy by 2 observers for evaluating the source of hematuria . Nephron. 1986;;44:304-308.
42 +
Pillsworth TJ, Haver VM, Abrass CK, Delaney CJ.  Differentiation of renal from non renal hematuria by microscopic examination of erythrocytes in urine . Clin Chem. 1987;;33:1791-1795.
43 +
Pollock C, Pei-Ling L, Gyory AZ, et al.  Dysmorphism of urinary red blood cells—value in diagnosis . Kidney Int. 1989;;36:1045-1049.
44 +
Schramek P, Schuster FX, Georgopoulos M, Porpaczy P, Maier M.  Value of urinary erythrocyte morphology assessment in symptomless microhematuria . Lancet. 1989;;2:1316-1319.
45 +
Shichiri M, Nishio Y, Suenaga M, et al.  Red cell volume distribution curves in diagnosis of glomerular and non glomerular hematuria . Lancet. 1988;;1:908-911.
46 +
Banks RA, Reynolds S, Hanbury D.  Identification of the source of hematuria by automated measurement of red cell volume . Br J Urol. 1989;;64: 45-48.
47 +
Docci D, Delvecchio C, Turci F, Turci A, Baldrati L, Martinelli A.  Detection of glomerular bleeding by urinary red cell size distribution . Nephron. 1988;;50:380-382.
48 +
Tsukahara H, Yoshimoto M, Morikawa K, Okada T, Kuroda M, Sudo M.  Urinary erythrocyte volume analysis: a simple method for detecting the site of hematuria in pediatric patients . J Pediatr. 1989;;115:433-436.
49 +
DeCaestecker MP, Hall CL, Basterfield PT, Smith JG.  Localization of haematuria by red cell analyzers and phase microscopy . Nephron. 1989;;52:170-173.
50 +
Gothlin JH, Gadeholt G, Hoiem L, Aslaksen A.  Changing scene of urology: value of urography as initial examination in infectious and hypertensive disease, hematuria, and malignant disease . Eur J Radiol. 1988;;8:135-139.
51 +
Dana A, Michel JR, Jungers P, Silbert-Zbili A, Droz D, Moreau JF.  Diagnostic etiologique des hematuries microscopiques . Nouv Presse Med. 1981;;10:963-966.
52 +
Jonsson K, Owman T.  Roentgenologic aspects of hematuria . Scand J Urol Nephrol. 1976;;10:229-234.
53 +
Barkin M, Lopatin W, Herschorn S, Comisarow R.  Unexplained hematuria . Can J Surg. 1983;;26:501-503.
54 +
Corwin HL, Silverstein MD.  The diagnosis of neoplasia in patients with asymptomatic microscopic hematuria: a decision analysis . J Urol. 1988;;139:1002-1006.
55 +
Warshauer DM, McCarthy SM, Street L, et al.  Detection of renal masses: sensitivities and specificities of execretory urography/linear tomography, US, and CT . Radiology . 1988;;169:363-365.
56 +
Clayman RV, Vilanur S, Miller RP, Reinke DB, Fraley EE.  Pursuit of the renal mass . Am J Med. 1984;;77:218-222.
57 +
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