Resumo

LOPES, Marta Sofia Cardoso et al. Microscopic hematuria: approach within the framework of primary health care. Rev Port Med Geral Fam [online]. 2018, vol.34, n.5, pp.327-333. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v34i5.11774.

Introduction: Microscopic hematuria (MH) is defined by the presence of at least three erythrocytes per high power field in the urine sediment, when properly collected, and without evidence of infection. This laboratory finding is often accidently detected by family physicians (FP), therefore its diagnostic approach should not be overlooked. MH can be classified as asymptomatic/symptomatic, transient/persistent and may be of benign or malignant nature. Objectives: To discuss the clinical evaluation of MH in adulthood, and to create an algorithm to guide FP on the differential diagnosis and clinical management. Methods: Search of meta-analysis, review articles and clinical guidelines (CG) published since 2010, in Portuguese and English. Databases: PubMed, Cochrane Library, DARE, NICE, UpToDate, Medscape. MeSH Keywords: ‘Hematuria’, ‘Microscopic findings’ and ‘Adult’. Free search in the American Urological Association and European Association of Urology. Results: A total of 265 articles were obtained. After duplicates’ removal, title screening, abstract screening and assessment of inclusion and exclusion criteria, one CG and two review articles were selected. Using the selected articles, we created an algorithm that synthesizes, in a practical way, the clinical management of MH in an adult patient. After excluding the possibility of contamination of the urine sample, the medical history and the physical examination of the urine sediment, combined with urine culture and the evaluation of kidney function, can provide clues for a specific diagnostic. In an asymptomatic patient, MH should be confirmed by performing a new urine sediment analysis, combined with urine culture and evaluation of kidney function. If the second laboratory test is negative, it is diagnosed as transient MH, which should be managed according to the patient’s risk for malignant disease. If MH is maintained, further information obtained from the sediment analysis (presence of proteins, dysmorphic erythrocytes, cylinders and/or clots) determines if the cause is glomerular or extra-glomerular. In the presence of extra-glomerular HM, the clinical management will depend on the presence of risk factors for malignant disease. Appointment referral to nephrology is mandatory in case of glomerular HM. Discussion: Microscopic hematuria is a laboratory sign that may indicate the presence of renal or/and urological pathology. A correct evaluation of the patient with MH shall include the determination of its etiology, upon which the subsequent clinical management will depend. As a frequent laboratory finding in primary care, FP should be aware of its main causes, and refer to secondary care whenever indicated.

Palavras-chave : Microscopic hematuria; Adult.

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