Haematuria can come from anywhere in the urinary tract. Suppose you have a patient who has isolated microscopic (dipstick +) haematuria and nothing much else. The signs that suggest urological disease and the signs that suggest renal disease are listed on the Edren Texbook page on haematuria
But if you've looked for all these things and they're negative, what should you do. For macroscopic haematuria that has drawn a blank, you will be particularly concerned and will look at your list of causes of haematuria hard. Think of everything. But it's still negative?
- Urinary albumin/creatinine ratio (ACR) can be useful, especially in young patients, as it will suggest early glomerulonephritis
If none of these are present, the recommendation is for occasional monitoring to make sure none of them are developing, over a prolonged period (years to decades). By occasional, maybe in 6 months then annually, indefinitely, of
- Blood pressure
- Proteinuria (might as well confirm continuing microscopic and not macroscopic haematuria too)
- Possibly serum creatinine
What could the underlying diagnosis be?
- Renal stones that you missed as they were tiny or had passed
- AV malformation
- Inherited GBM disorder - for instance early Alport syndrome, or more commonly thin GBM disease. Alport carriers often have a thin GBM, but more than half of patients, including some with a family history, do not seem to have this explanation.
- Early nephritis - typically a long slow disorder such as IgA nephropathy, but could be any of a number of 'nephritic' type diseases. See nephritic end of the spectrum
(Not a complete list!)