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ACP Presents High-Value Care Advice for Hematuria

Seven pieces of high-value care advice presented to clinicians for evaluating patients with hematuria

urine specimen

TUESDAY, Jan. 26, 2016 (HealthDay News) -- In a clinical guideline published online Jan. 26 in the Annals of Internal Medicine, recommendations relating to evaluation of hematuria are presented for clinicians.

Matthew Nielsen, M.D., from the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, and Amir Qaseem, M.D., Ph.D., from the American College of Physicians in Philadelphia, conducted a narrative review of available clinical guidelines and relevant studies in the evaluation of hematuria.

The authors provide seven pieces of high-value care advice. Gross hematuria should be included in routine review of systems; patients with microscopic hematuria should be asked about gross hematuria. Screening urinalysis should not be used for cancer detection in asymptomatic adults. Before initiating further evaluation in asymptomatic adults, heme-positive results of dipstick testing should be confirmed with microscopic urinalysis. All adults with gross hematuria, even if self-limited, should be referred for further urologic analysis. For adults with microscopically confirmed hematuria in the absence of some benign cause, urologic referral should be considered for cystoscopy and imaging. Hematuria evaluation should be pursued even if the patient is receiving antiplatelet or anticoagulant therapy. In the initial evaluation of hematuria, clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection.

"Physicians should be aware of risk factors for cancer when considering the finding of hematuria," Wayne J. Rily, M.D., president of the American College of Physicians, said in a statement.

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