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Conditions

Non-visible Haematuria

Condition: Non-visible Haematuria

Section Author: Jon Rees

Review Date: September 2017

Overview

Another controversial issue – the management of non-visible haematuria (NVH) in primary care.

Non-visible haematuria is now the recommended terminology, replacing phrases such as ‘dipstick haematuria’ and ‘microscopic haematuria’.

Some key issues for primary care:

  1. When to test for haematuria – screening is not recommended, and much of the difficulty in managing this finding can be avoided if urine is tested for blood only in appropriate circumstances.
  2. When to refer patients with NVH to secondary care for further investigation – not all patients with NVH need urological or nephrological assessment – patients with asymptomatic NVH found below the age of 40, with normal renal function, can be managed in primary care – the BAUS / Renal Association guidelines have full detail of this.
  3. When to refer patients with NVH via the 2 week wait suspected cancer pathway – this was updated in 2015 in the NICE Referral for Suspected Cancer Guidelines. Remember though that if patients do not meet the 2 week wait criteria, they may still need referral outside of this pathway, according to the BAUS / Renal Association guidelines, which still apply. NICE guidelines should only be used to determine the urgency of referral.

Summary of NICE guidance (all haematuria ie including Visible Haematuria), June 2015:

Remember that the criteria below ONLY tell you who to refer urgently via a two week wait pathway – many patients who do not meet these criteria will need an urgent urological referral for further investigation.

Healthcare Professional Links

Guidelines for management of non-visible haematuria in primary care – produced by British Association of Urological Surgeons and the Renal Association in 2009, and still the key document to understand: ‘Assessment and management of non-visible haematuria in primary care’. Kelly JD et al. BMJ 2009; 338: a3021. http://www.bmj.com/content/338/bmj.a3021

Haematuria – 10 Top Tips for Primary Care, published by MacMillan Cancer Support 2016: http://www.macmillan.org.uk/documents/aboutus/health_professionals/primarycare/10toptips/primary-care-ten-tips-haematuria.pdf

NICE guideline (NG12): Suspected cancer: recognition and referral. June 2015. https://www.nice.org.uk/guidance/ng12

‘Blood in Pee’ campaign – information from Cancer Research UK: http://www.cancerresearchuk.org/health-professional/early-diagnosis-activities/be-clear-on-cancer/blood-in-pee-campaign/information-for-gps-and-other-healthcare-professionals#ordercampaignmaterials

‘Blood in Pee’ campaign – information for patients on NHS Choices: https://www.nhs.uk/be-clear-on-cancer/symptoms/blood-in-pee#IGuglv5yUoT2V28U.97

info

Kelly JD et al. BMJ 2009; 338: a3021

Information for patients

BAUS http://www.baus.org.uk/patients/conditions/2/blood_in_the_urine_haematuria

Renal Association http://www.renal.org/information-resources/the-uk-eckd-guide/haematuria

Administration: Janis.Troup@rightangleuk.com and Sabah.Allawati@rightangleuk.com