Hematuria Evaluation
Hematuria is a symptom, not a diagnosis — and the job is to decide who needs a cancer workup and how aggressive it should be.
The big picture
Hematuria is a symptom, not a diagnosis — and the job is to decide who needs a cancer workup and how aggressive it should be. The modern AUA approach risk-stratifies microhematuria (rather than scoping everyone), while gross (visible) hematuria is high-risk by default. The first fork is always: is this glomerular (medical, → nephrology) or urologic (surgical, → cancer workup)?
The framework: define it (gross vs micro, ≥3 RBC/hpf) → glomerular vs urologic source → risk-stratify microhematuria (low/intermediate/high) → matched workup (cystoscopy + imaging).
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Microhematuria = ≥3 RBC/hpf on microscopy (confirm — dipstick also reacts to Hb/myoglobin).
Gross hematuria is high-risk by default → cystoscopy + CT urography.
Dysmorphic RBCs / casts / proteinuria → glomerular → nephrology, don't scope.
AUA microhematuria workup: low = shared decision; intermediate = cystoscopy + RUS; high = cystoscopy + CT urogram.
Lynch syndrome is a high-risk factor (UTUC link).
CT urography is the upper-tract imaging of choice (MR urography/RGP if contraindicated).