This site is intended for healthcare professionals

Ep 20 – Management of non-visible haematuria (microscopic haematuria) in primary care

In this episode, Kevin looks at common questions around non-visible haematuria (NVH) – the condition formerly known as microscopic haematuria. Should we be screening for NVH? What follow-up investigations should we do for people with asymptomatic NVH? Should we change our approach for patients taking aspirin, warfarin or direct-acting oral anticoagulants (DOACs)? Finally, who should we refer and how urgently?

Key references and resources discussed in the episode:

 

Key take-home points from the episode:

  1. There is no compelling evidence to support population screening for NVH in asymptomatic people.
  2. 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.
  3. 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.
  4. 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.

Share this episode:

Share on facebook
Share on twitter
Share on linkedin
Share on email
Share on whatsapp

Thanks for your feedback. Please note that by including your email address, you are giving permission for us to contact you by email to help resolve any issues.

GPnotebook_podcast_white-text

Would you like to receive updates about new podcast episodes by email? (You can unsubscribe at any time)