Visible (also known as macroscopic or frank) haematuria
- Usually fast track Urology referral for imaging and cystoscopy unless strong pointers to acute renal disease
Invisible (also known as microscopic) haematuria
- Use reagent strips rather than urine microscopy for detection. (There is no need to perform microscopy to confirm a positive result).
- Evaluate further if there is a result of 1+ or more
- Measure renal function and assess for proteinuria in all cases
- Usually refer to urology (see local guidance for referral pathways). If renal impairment and/or proteinuria also present, consider simultaneous referral to nephrology.
Age <40 or >40 with negative urological investigations
- If no proteinuria AND eGFR > 60 ml/min/1.73m2 manage as CKD stage G1/G2 otherwise refer to nephrology
Information for patients
Haematuria means blood in the urine. Sometimes this is visible to the naked eye or it may only be detected by a urine dipstick test or when urine is examined using a microscope. Lots of different conditions can result in blood urine in the urine. The most likely cause varies depending on your age, if you are leaking protein (as well as blood) in the urine and whether your kidney function is impaired. Further investigations may be required to find the cause.