HEMATURIA

Many serious and potentially treatable diseases of the urinary tract m ay have haematuria as their only manifestation. However, asymptomatic microscopic haematuria detected by dipstick testing may be seen in up to 16% of screening populations. The great majority of such cases will have no sinister underlying cause, particularly in those under 40 yea rs of age, and so the schedule of further investigations, some of whic h may be invasive, time-consuming and expensive, needs to be rationali sed. In addition, the increasing popularity of 'fast track' clinics fo r the investigation of haematuria enhances the need for a clear strate gy of investigation. Analysis of the epidemiology of asymptomatic haem aturia and its causes combined with a consideration of the risk-benefi t profile of the available investigations, makes it possible to set ou t an algorithm for the initial management of this common finding. Care ful clinicial assessment and basic laboratory tests for renal function , analysis of the urinary sediment and cytological examination of the urine are followed by ultrasound and plain radiography of the urinary tract. Flexible cystoscopy under local anaesthetic is central to the a lgorithm in patients of all ages. The importance of a nephrological op inion and consideration of renal biopsy, especially in younger patient s with other evidence of glomerular disease, is stressed. The role of intravenous urography in excluding pathology of the upper urinary trac t, especially in patients over the age of 40, is also considered.