An 81 year old lady has persistent microscopic haematuria and negative MSUs. She is also on warfarin (last INR 3.4) for AF and has hypertension (last BP 162/80).
She has a history of cutaneous vasculitis and was seen by dermatology regarding a lesion on her leg a few years ago, but this all seemed to settle. Urology investigated the same problem of microscopic haematuria 2 years ago and all investigations were normal.
Her ESR is slightly up at 28, but I wonder if the most likely cause is her raised BP and possibly warfarin use, but I would be grateful for your advice as to whether I should be doing anything else or you would wish to see her?
What further information would you seek before giving your opinion?
See more of the history or available results?
Blood – ESR 28 / CRP – 2 / eGFR 51 (stable compared to previous results)
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Given your history and normal urological investigations, I would be tempted to just carry on doing what you’re doing, albeit with some further BP control.
It seems unlikely that after this long without progression, her haematuria is caused by systemic vasculitis, but an ANCA would be informative if positive.
However the golden rule is that with normal urological investigations, normal renal function (eGFR of 51 if stable will do at 81), no proteinuria and normotensive, then microscopic haematuria can simply be observed. I would monitor these variables – infrequently – and see what happens. We can always review the situation if things are changing but I think she’ll just remain stable.
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Things to read:
- Edinburgh Renal Unit – GP Referral criteria
- Edinburgh Renal Unit – Microscopic Haematuria
- NICE CKD Guidelines including management of isolated microscopic haematuria – NICE CKD