Haematuria

Key points

• Haematuria requires a structured assessment. Visible haematuria and persistent/unexplained non-visible haematuria may indicate urinary tract malignancy, stones, infection or glomerular disease; NICE referral criteria should guide suspected-cancer referral.
• Urinary tract infection can cause haematuria, but persistent haematuria after appropriate treatment requires reassessment rather than being repeatedly attributed to UTI.
• Vigorous exercise can cause transient haematuria, which usually resolves after cessation; persistent haematuria should not be dismissed as exercise-related.
• Sexual intercourse can cause transient urinary/genital bleeding or contamination, but it is not an adequate explanation for persistent non-visible haematuria. Persistent haematuria requires assessment for renal/glomerular, stone, infection and urological causes.
• MRCP cancer clue: visible haematuria in adults ≥45 years without UTI, or persistent/recurrent visible haematuria after UTI treatment → suspected-cancer pathway referral for renal/bladder cancer.
• Glomerular clue: haematuria + significant albuminuria/proteinuria, dysmorphic RBCs or RBC casts → think glomerular disease rather than isolated urological bleeding.