Evaluation of non-visible hematuria

Last reviewed: 2 Apr 2025
Last updated: 25 Jun 2024

Summary

Differentials

Common

  • Menstruation
  • Cystitis (urinary tract infection)
  • Pyelonephritis
  • Nephrolithiasis
  • Acute prostatitis
  • Benign prostatic hyperplasia (BPH)
  • Trauma (sexual activity, exercise, contusion)
Full details

Uncommon

  • Bladder stone
  • Renal cell carcinoma
  • Urothelial cancer (upper tract)
  • Simple renal cyst
  • Polycystic kidney disease
  • Medullary sponge kidney
  • Atrophic kidney
  • Calyceal diverticulum
  • Renal infarction
  • Renal vein thrombosis
  • Arteriovenous malformations
  • Papillary necrosis
  • Sickle cell disease
  • Hydronephrosis
  • Ureteropelvic junction obstruction
  • Vesicoureteral reflux
  • IgA nephropathy
  • Thin glomerular basement membrane disease
  • Acute glomerulonephritis
  • Lupus nephritis
  • Hereditary nephritis (Alport syndrome)
  • Urothelial cancer (bladder)
  • Cystitis (interstitial)
  • Cystitis (radiation-induced)
  • Cystitis (eosinophilic)
  • Bladder diverticulum
  • Bladder papilloma
  • Prostate cancer
  • Prostate stone
  • Bladder neck contracture
  • Urethritis
  • Urethral stricture
  • Phimosis
  • Penile cancer
  • HIV
  • Lymphoma
  • Multiple myeloma
  • Urinary tract tuberculosis
Full details

Contributors

Authors

Timothy J. Benton, MD
Timothy J. Benton

Regional Chairman

Professor

Department of Family and Community Medicine

Texas Tech University Health Sciences Center at the Permian Basin

Odessa

TX

Disclosures

TJB declares that he has no competing interests.

Beverly Axe-Lewis, DO

Associate Professor

Regional Chief Medical Informatics Officer

Medical Director Haven Health Clinics

Department of Family Medicine

Texas Tech University Health Sciences Center

Amarillo

TX

Disclosures

BAL declares that she has no competing interests.

Peer reviewers

Brian J. Linder, MD, MS

Associate Professor of Urology and Obstetrics/Gynecology

Mayo Clinic

Rochester

MN

Disclosures

BJL declares that he has no competing interests.

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

TX

Disclosures

RT declares that he has no competing interests.

Junaid Masood, MBBS, FRCS (Eng), MSc (Urol), FRCS (Urol)

Consultant Urological Surgeon

Bart's and The London NHS Trust

London

UK

Disclosures

JM declares that he has no competing interests.

References

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Key articles

Barocas DA, Boorjian SA, Alvarez RD, et al. Microhematuria: AUA/SUFU Guideline. J Urol. 2020 Oct;204(4):778-86.Full text  Abstract

American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice, American Urogynecologic Society. Committee opinion no. 703: asymptomatic microscopic hematuria in women. Jun 2017 [Internet publication]​.Full text

Nielsen M, Qaseem A; High Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2016;164:488-497.Full text  Abstract

Linder BJ, Bass EJ, Mostafid H, et al. Guideline of guidelines: asymptomatic microscopic haematuria. BJU Int. 2018 Feb;121(2):176-83.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: hematuria. 2019 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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