Clinical Case 72: Answer and Summary

A 62 year old male with sole microscopic hematuria is asked to seek renal consultation. He has had 3-4 urine samples in the last year with this finding. What would you do next?

Seroligcal workup           0%

Kidney biopsy                2%

Follow closely, nothing specific now        7%

ACEI or ARB therapy                            2%

Urological workup                               87%

This is a common situation faced by many. This can be seen mostly in primary care settings and usually in this age group, urological workup to rule out malignancy of the GU track is likely the first thing to do. But then again, the role of cystoscopy is uncertain in patients with unexplained persistent microscopic hematuria who have no risk factors for malignancy( smoking history, weight loss, B symptoms). The AUA recommendations on asymptomatic microscopic hematuria included the following risk factors for malignancy: ( coutesy AUA and uptodate.com)

• Age >35 years
• Smoking history in which the risk correlates with the extent of exposure
• Occupational exposure to chemicals or dyes (benzenes or aromatic amines)
• History of gross hematuria
• History of chronic cystitis or irritative voiding symptoms
• History of pelvic irradiation
• History of exposure to cytoxan
• History of a chronic indwelling foreign body
• History of analgesic abuse, which is also associated with an increased incidence of carcinoma of the kidney 

 Following that being negative, the choices can be variable. Most would likely follow closely and do nothing specific or potentially do a kidney biopsy. Usually the renal disease with just the above findings has a limited differential and usually benign.