Key references and resources discussed in the episode:
Key take-home points from the episode:
- There is no compelling evidence to support population screening for NVH in asymptomatic people.
- All those with persistent NVH require primary care follow-up to exclude progressive kidney disease.
- Persistent is defined as asymptomatic NVH that persists for at least two out of three samples, separated by 2–3 weeks.
- Assess baseline renal status: blood pressure, urea and electrolytes and urinary albumin to creatinine ratio.
- Individuals on aspirin, warfarin or DOACs should be managed in the same way as those not on these drugs.
- Those <40 years with persistent NVH and normal baseline renal function need annual primary care monitoring for as long as the NVH persists (until two negative urinalyses).
- Refer to renal if estimated glomerular filtration rate (eGFR) is <30 mL/min/1.73 m2 on two separate occasions or eGFR falls by >5 mL/min/1.73 m2 over 1 year or >10 mL/min/1.73 m2 over 5 years or the person develops proteinuria.
- Those ≥40 years require referral to urology.
- NICE 2015 suspected cancer guideline suggests an urgent 2 week wait referral for bladder cancer if the person is ≥60 years and has unexplained NVH and either dysuria or a raised white cell count.
- Scottish 2019 cancer guidance suggests:
- An urgent suspicion of cancer referral for those ≥60 years with unexplained NVH and either dysuria or a raised white cell count.
- Routine referral for all those with asymptomatic persistent NVH without obvious cause.