Hematuria: Just UTI - Or something more ominous?

The presence of blood in the urine is a significant finding that calls for prompt evaluation. Gross hematuria usually indicates a serious problem; its correlation with malignancy - typically a transitional cell carcinoma - is fairly high. Microscopically detectable blood is less likely to signal a major underlying condition; a finding of 0 to 3 red cells per high-power field is probably innocent. The work-up for gross and microscopic hematuria focuses on disturbances of urinary tract function and includes a history and physical examination, urinalysis, intravenous pyelography, urine cytology, and cystoscopy. The presence of hematuria, proteinuria, and renal insufficiency warrants referral to a nephrologist. A search for the cause of microscopic hematuria is more likely to create an iatrogenic problem than to uncover a life-threatening condition; if the hematuria persists, repeat the urinalysis and cytology every 6 months until the problem resolves or 3 years have passed.