Matthew Nielsen, MD, MS; Amir Qaseem, MD, PhD; for the High Value Care Task Force of the American College of Physicians *
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations.
Financial Support: Financial support for the development of this article comes exclusively from the American College of Physicians operating budget. Dr. Nielsen is supported by the American Cancer Society (grant MRSG-13-154-01-CPPB) and the Urology Care Foundation/Astellas (Rising Stars in Urology Research Award).
Disclosures: Dr. Nielsen reports personal fees from the American College of Physicians during the conduct of the study, other from Grand Rounds and Urology Care Foundation/Astellas outside the submitted work, and grants from the American Cancer Society and National Institutes of Health outside the submitted work. Authors not named here have disclosed no conflicts of interest. Forms can also be viewed at www.acponline.org/authors/icjme/ConflictOfInterestForms.do?msNum=M15-1496. Authors followed the policy regarding conflicts of interest described at www.annals.org/article.aspx?articleid=745942. A record of disclosures of interest is kept for each High Value Care Task Force meeting and conference call and can be viewed at http://hvc.acponline.org/clinrec.html.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Nielsen: University of North Carolina Lineberger Comprehensive Cancer Center, 2107 Physicians Office Building, Campus Box 7235, Chapel Hill, NC 27599.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Author Contributions: Conception and design: M. Nielsen, A. Qaseem.
Analysis and interpretation of the data: M. Nielsen, A. Qaseem.
Drafting of the article: M. Nielsen, A. Qaseem.
Critical revision of the article for important intellectual content: M. Nielsen, A. Qaseem.
Final approval of the article: M. Nielsen, A. Qaseem.
Statistical expertise: A. Qaseem.
Obtaining of funding: A. Qaseem.
Administrative, technical, or logistic support: A. Qaseem.
Collection and assembly of data: M. Nielsen.
The presence of blood in the urine, or hematuria, is a common finding in clinical practice and can sometimes be a sign of occult cancer. This article describes the clinical epidemiology of hematuria and the current state of practice and science in this context and provides suggestions for clinicians evaluating patients with hematuria.
A narrative review of available clinical guidelines and other relevant studies on the evaluation of hematuria was conducted, with particular emphasis on considerations for urologic referral.
Clinicians should include gross hematuria in their routine review of systems and specifically ask all patients with microscopic hematuria about any history of gross hematuria.
Clinicians should not use screening urinalysis for cancer detection in asymptomatic adults.
Clinicians should confirm heme-positive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults.
Clinicians should refer for further urologic evaluation in all adults with gross hematuria, even if self-limited.
Clinicians should consider urology referral for cystoscopy and imaging in adults with microscopically confirmed hematuria in the absence of some demonstrable benign cause.
Clinicians should pursue evaluation of hematuria even if the patient is receiving antiplatelet or anticoagulant therapy.
Clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection in the initial evaluation of hematuria.
Nielsen M, Qaseem A, for the 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. [Epub ahead of print 26 January 2016]. doi: 10.7326/M15-1496
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Published: Ann Intern Med. 2016;164(7):488-497.
Published at www.annals.org on 26 January 2016
Guidelines, Nephrology, Urological Disorders.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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