Haematuria - non-visible

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Assessment

Transient non-visible haematuria is common and does not require investigation. Persistent non-visible haematuria is:

  • At least 1+ on dipstick
  • On at least 2 occasions in a 4-6 week period

If negative or only trace on repeat further investigations not needed.

Consider:

  • History of renal stones
  • History of urological malignancy
  • ?related to menstruation, medication, exercise

Examination

  • Exclude abdominal mass
  • Consider DRE/PV
  • Blood pressure

Primary care management

Investigations

  • MSSU
  • FBC
  • U&E
  • ACR/PCR
  • Consider PSA but ensure negative MSSU first

If MSSU positive then treat appropriately

Who to refer?

Refer Urology Urgent Suspicion of Cancer

  • Age 60 or over with persistent non-visible haematuria, negative MSU and persistent irritative lower urinary symptoms

Refer Urology Urgent 

  • Age under 60 with persistent non-visible haematuria, negative MSU and persistent irritative lower urinary symptoms

Refer Urology Routinely

  • Age > 35 with unexplained non-visible haematuria on 3 or more occasions

Refer via SCI-Gateway...Urology...Fast track Haematuria referral

Consider Renal referral if age < 40 and:

  • eGFR < 30
  • proteinuria - ACR > 30 or PCR > 50
  • BP > 140/90
  • eGFR dropped by 10ml/min in past 5 years or 4 ml/min past year

Who not to refer?

  • Patients investigated in the past 5 years for non-visible haematuria with no new symptoms
  • Patients age < 40 with no other symptoms and normal renal function and urinary ACR/PCR.

Editorial Information

Last reviewed: 04/12/2023

Next review date: 04/12/2024

Author(s): Ian Russell.

Version: 1.1