Assessment and management of non-visible haematuria in primary care

#### Summary points Many clinicians are not sure what constitutes clinically relevant haematuria; they are also unsure about when patients with haematuria should be referred for specialist assessment and whether they should be referred to a urologist, nephrologist, or both. In 2006 the National Institute for Health Research, Health Technology Assessment (NIHR HTA) commissioned a systematic review of the evidence for the investigation of microscopic haematuria, with a view to developing an algorithm for assessing patients in primary care.1 They concluded that, “Given the paucity of evidence . . . it is not possible to derive an algorithm of the diagnostic pathway for haematuria that would be solely supported by existing evidence.” None the less, the investigation of microscopic haematuria is important because serious underlying conditions are present in a proportion of patients. #### Sources and selection criteria We drew on evidence published in the systematic reviews of the National Institute for Health and Clinical Excellence, Health Technology Assessment (microscopic haematuria),1 and guidelines for the early diagnosis and management of chronic kidney disease.1 2 We searched electronic databases, including Medline and the Cochrane database, to identify recent publications and studies that were deemed relevant but outside the inclusion criteria of the systematic review. We included the evidence presented in published guidelines for the investigation …