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Peer Reviewed

What's The Take-Home?

A 39-Year-Old Man With Microscopic Hematuria

Ronald N. Rubin, MD1,2 —Series Editor

Volume 62 - Issue 6 - June 2022

  • AFFILIATIONS:
    1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
    2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania

    CITATION:
    Rubin RN. A 39-year-old man with microscopic hematuria. Consultant. 2022;62(6):e39-e41. doi:10.25270/con.2022.06.00013

    DISCLOSURES:
    The author reports no relevant financial relationships.

    CORRESPONDENCE:
    Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 (blooddocrnr@yahoo.com)

     

    A 39-year-old man attended a “screening day” sponsored by his workplace. At the event, a nurse practitioner took his medical history; performed a physical examination; drew blood for lipid studies, a complete blood cell panel, and metabolic panel; collected a stool sample for occult blood screening; collected a urine sample for a urinalysis; and conducted an electrocardiography scan.

    The man’s history was wonderfully negative for serious illness. He had no major medical diagnoses or surgical history. He had an administrative white-collar job, regularly went to the gym, and was in good physical shape. His examination findings were entirely within normal limits, including blood pressure (110/70 mmHg) and BMI (22 kg/m2).

    However, the next day he was given a report and summary of his findings that demonstrated the urinalysis dipstick stained faintly positive for blood. A microscopic urine examination revealed 3 to 5 red blood cells per high power field (RBC/HPF). Everything else was nonremarkable and within normal limits. The summary prompted him to see a physician for further evaluation of the urine abnormality.

    Which of the following statements most accurately describes the approach and management pertaining to the case presented?

    1. If a decision for further evaluation is made, initial optimal studies are ultrasonography and cystoscopy.
    2. The routine screening for urinary tract cancers via urinalysis the patient had received has been validated as an effective genitourinary tract cancer screening method.
    3. The finding of microscopic hematuria as described in our patient requires obligatory and prompt urologic/radiologic follow-up.
    4. Both microscopic and gross hematuria in adults carries high and equivalent cancer risk.

     

    Answer and discussion on next page.

     

References

1. Tan WS, Feber A, Sarpong R, et al. Who should be investigated for haematuria? Results of a contemporary prospective observational study of 3556 patients. Eur Urol. 2018;74(1):10-14. doi:10.1016/j.eururo.2018.03.008

2. Ingelfinger JR. Hematuria in adults. N Eng J Med. 2021;385(2);153-163. doi:10.1056/NEJMra1604481

3. Cohen RA, Brown RS. Clinical practice. Microscopic hematuria. N Engl J Med. 2003;348(23):2330-2338. doi:10.1056/NEJMcp012694

4. Davis R, Jones JS, Barocas DA, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012;188(6 Suppl):2473-2481. doi:10.1016/j.juro.2012.09.078

5. Nielsen M, Qaseem A; High Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2016;164(7):488-497. doi:10.7326/M15-1496

6. Halpern JA, Chughtai B, Ghomrawi H. Cost-effectiveness of common diagnostic approaches for evaluation of asymptomatic microscopic hematuria. JAMA Intern Med. 2017;177(6):800-807. doi:10.1001/jamainternmed.2017.0739

7. Subak LL, Grady D. Asymptomatic microscopic hematuria-rethinking the diagnostic algorithm. JAMA Intern Med. 2017;177(6):808-809. doi:10.1001/jamainternmed.2017.0758

8. Bauer SR, Carroll PR, Grady D. Hematuria practice guidelines that explicitly consider harms and costs. JAMA Intern Med. 2019;179(10):1362-1364. doi:10.1001/jamainternmed.2019.226