Workup-of-hematuria

(NEJM 2021;385:153)

• Urine dipstick: ⊕ if ≥3 RBCs; ⊕ dipstick and ⊖ sediment → myo- or hemoglobinuria

• Urine sediment: dysmorphic RBCs or RBC casts → GN → consider renal bx

• If suggestive sx, r/o UTI or nephrolithiasis

• Low cancer risk: repeat U/A in 4–6 wks; if still ⊕ → cystoscopy + imaging

• Intermediate risk (eg, ♂ 40–59 yrs or ♀ 50–59 yrs or 10–30 pack-yrs): cystoscopy + U/S

• High risk (eg, age ≥60 or >30 pack-yrs): CT urography (Se 96%, Sp 98%) + cystoscopy

• Rx: if obstruction: bladder irrigation and 3-way Foley on CBI