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Microscopic haematuria is now more aptly termed non-visible haematuria (NVH).

This can be subdivided into symptomatic NVH with the presence of lower urinary tract symptoms, or asymptomatic NVH When screening for haematuria, urinary reagent strips should be used rather than urine microscopy.

Thus, the reaction is very sensitive and will detect haematuria, haemoglobinuria and myoglobinuria.

Microscopy of the urine will determien whether there are red cells there This 2008 article by Pravin Kumar called ' How to evaluate ‘dipstick haematuria’: What to do before you refer' is a very good summary for GPs Any episode of visible haematuria or symptomatic NVH in the absence of a urinary tract infection (UTI) or transient cause is considered significant.

Trace haematuria should be considered negative It is important to Investigate symptomatic and persistent asymptomatic haematuria by: (i) excluding UTIs or other transient causes (ii) checking creatinine/e GFR (iii) sending urine for ACR or PCR on a random sample (iv) measuring blood pressure (BP) (BAUS/RA 2008) Key Point: all patients with significant visible or symptomatic non-visible haematuria, and patients over the age of 40 years with symptomatic non-visible haematuria, should be referred to urology, to exclude carcinoma - using the 2 week cancer wait system An exception of referring directly to a nephrologist may be a young adult who has haematuria (cola-coloured!Relative contraindications may be extreme obesity, small kidneys (less than 9 cm) and single kidney • Genetic testing.Although two gene mutations (PKD1 and PKD2) have been identified in patients with polycystic kidney disease, the test is not widely available, and its utility remains questionable.There are potentially some instances when this test may be useful (eg in a family when the mutation is already known), but widespread adoption of this test is not considered appropriate at the present time (i) Blood pressure control.BP control is mandatory in any patient with CKD, first to slow down the progress of renal impairment and, second, to reduce the risk of cardiovascular events.

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) and an intercurrent illness (usually an upper respiratory tract infection), and who is suspected of having acute glomerulonephritis For those with haematuria but no proteinuria, there should be annual testing for haematuria, albuminuria/proteinuria, e GFR and BP monitoring, as long as the haematuria persists.

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