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Last updated: 30 March, 2020 15:59pm

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Non-visible Haematuria (NVH) – Information for GPs

Referral criteria / commissioning position

Refer to Urology if:

  • visible haematuria or symptomatic NVH develops

In patients under 50 years of age with microscopic haematuria, the urine should be tested for proteinuria and serum creatinine levels measured. Those with proteinurea or raised serum creatinine should be referred to a renal physician. If there is no proteinuria and serum creatinine is normal, a non-urgent referral to a urologist should be made.

In patients aged 50 years and older who are found to have unexplained microscopic haematuria, an urgent referral should be made.

Refer to Nephrology if:

  • ACR increases >30 or PCR >50
  • eGFR decreases to <30 without other obvious cause, measured on 2 occasions deteriorating eGFR (>5ml/min over 1 year or 10ml/min over 5 years)

Red Flags include:

  • visible (frank) haematuria (in adult) without UTI
  • solid swelling in body of testis
  • palpable renal mass
  • elevated age specific PSA in men with ten year life expectancy
  • high PSA (>20ng/ml) in man with clinically malignant prostrate or bone pain
  • any suspected penile cancer

Investigations prior to referral

  • BP
  • creatinine, eGFR
  • urine ACR or PCR

Information to include in referral letter

  • Evidence that transient or spurious causes of NVH has been excluded
  • Previous history of NVH and any investigations carried out
  • Relevant past medical/surgical history
  • Drug history (prescribed and non-prescribed)
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient Information Leaflets

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