A patient will be asked a number of questions:
- Have you passed any blood clots?
- Has a kidney stone been passed (noise in toilet bowl)?
- Is the red colour mixed in completely, or does the colour change during an episode of urination?
- Does it occur only after getting up?
- Have you recently had a sore throat?
Often, the diagnosis is made on the basis of the medical history and some blood tests - especially in young people in whom the risk of malignancy is negligible and the symptoms are generally self-limited.
Ultrasound investigation of the renal tract is often used to distinguish between various sources of bleeding. X-rays can be used to identify kidney stones, although CT scanning is more precise.
In older patients, cystoscopy with biopsy of suspected lesions is often employed to investigate for bladder cancer.
If combined with pain, it may be ''loin pain hematuria syndrome''.
Per AUA (American Urologic Association) guidelines, the following should be performed for high risk patients with significant microhematuria (greater than three red blood cells per high powered field):
- Upper tract imaging of which a CT urogram is the gold standard
- Urine cytology
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