Sandbox:Microscopic hematuria: Difference between revisions
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== Prevalence == | == Prevalence == | ||
The prevalence of microscopic hematuria ranges from 1-20% depending on the population studied. The likelihood of finding significant urologic disease in these patients also varies with associated risk factors which include: | |||
* Older age | |||
* Male gender | |||
* History of cigarette smoking | |||
* History of chemical exposure (cyclophosphamide, benzenes, aromatic amines) | |||
* History of pelvic radiation | |||
* Irritative voiding symptoms (urgency, frequency, dysuria) | |||
* Prior urologic disease or treatment | |||
The prevalence of microscopic hematuria varies depending on age, gender, frequency of testing, threshold used to define MH and presence of risk factors such as smoking.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref> | The prevalence of microscopic hematuria varies depending on age, gender, frequency of testing, threshold used to define MH and presence of risk factors such as smoking.<ref name="pmid23098784">Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23098784 Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline.] ''J Urol'' 188 (6 Suppl):2473-81. [http://dx.doi.org/10.1016/j.juro.2012.09.078 DOI:10.1016/j.juro.2012.09.078] PMID: [https://pubmed.gov/23098784 23098784]</ref> | ||
Revision as of 18:55, 30 November 2016
http://www.jurology.com/article/S0022-5347(12)04958-0/pdf
Definition
Microscopic hematuria is defined as the presence of three or greater red blood cells per high powered field on a properly collected urinary specimen in the absence of an obvious benign cause.[1]
Causes
Overview
The causes of MH are either urologic or nephrologic. The most common urological etiologies are benign prostatic enlargement, infection and urinary calculi.
Prevalence
The prevalence of microscopic hematuria ranges from 1-20% depending on the population studied. The likelihood of finding significant urologic disease in these patients also varies with associated risk factors which include:
- Older age
- Male gender
- History of cigarette smoking
- History of chemical exposure (cyclophosphamide, benzenes, aromatic amines)
- History of pelvic radiation
- Irritative voiding symptoms (urgency, frequency, dysuria)
- Prior urologic disease or treatment
The prevalence of microscopic hematuria varies depending on age, gender, frequency of testing, threshold used to define MH and presence of risk factors such as smoking.[1]
Asymptomatic microscopic hematuria in the general population is common. The prevalence of some degree of hematuria has been reported to be as high as 9% to 18% in large screening studies.[2]
The prevalence of MH may be higher in women because of benign conditions but the prevalence of urological cancers in women is low ( e.g. In women risk of bladder cancer is 3- to 4-fold lower, and risk of renal cancer is 2-fold lower, compared with men)[3]
Diagnosis
A positive dipstick does not define MH, and evaluation should be based solely on findings from microscopic examination of urinary sediment and not on a dipstick reading. A positive dipstick reading merits microscopic examination to confirm or refute the diagnosis of MH.Patients who have a positive dipstick test but a negative specimen on microscopy should have three additional repeat tests. If at least one of the repeat tests is positive on microscopy, then work-up should be undertaken. If all three specimens are negative on microscopy, then the patient may be released from care.[1]
American Urological Association (AUA) best practice policy recommendations include urine testing (urine culture or urine cytologic testing), imaging (multiphase abdominal computed tomography [CT] or intravenous pyelography plus renal ultrasonography), and cystoscopy.[2]
Because MH has been associated with underlying urologic cancer, the AUA recommends evaluation with cystoscopy and upper tract imaging, preferably with computer tomography (CT) scan, for all patients >35 years of age with this finding.
References
- ↑ 1.0 1.1 1.2 Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ et al. (2012) Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 188 (6 Suppl):2473-81. DOI:10.1016/j.juro.2012.09.078 PMID: 23098784
- ↑ 2.0 2.1 Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G et al. (2013) Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc 88 (2):129-38. DOI:10.1016/j.mayocp.2012.10.004 PMID: 23312369
- ↑ Lippmann QK, Slezak JM, Menefee SA, Ng CK, Whitcomb EL, Loo RK (2016) Evaluation of microscopic hematuria and risk of urologic cancer in female patients. Am J Obstet Gynecol ():. DOI:10.1016/j.ajog.2016.10.008 PMID: 27751797