What are the ACP treatment guidelines for hematuria?

Updated: Jan 03, 2019
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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Answer

Guidelines on hematuria from the American College of Physicians (ACP) advises that clinicians should include gross hematuria in their routine review of systems and specifically ask all patients with microscopic hematuria about any history of gross hematuria. [1, 2]

The ACP also recommend that [1, 2] :

  • Clinicians should not use screening urinalysis for cancer detection in asymptomatic adults.

  • Clinicians should confirm heme-positive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults.

  • Clinicians should refer for further urologic evaluation in all adults with gross hematuria, even if self-limited.

  • Clinicians should consider urology referral for cystoscopy and imaging in adults with microscopically confirmed hematuria in the absence of some demonstrable benign cause.

  • Clinicians should pursue evaluation of hematuria even if the patient is receiving antiplatelet or anticoagulant therapy.

  • Clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection in the initial evaluation of hematuria.


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