Red urine, yellow urine, red urine, yellow urine: Managing Haematuria

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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS).

In this episode, consultants Prof Jeremy Levy and Dr Andrew Frankel, both nephrologists at Imperial College Healthcare NHS Trust, discuss the significance and management of microscopic (non-visible) haematuria in primary care. They provide practical guidance for general practitioners on how to interpret urine dipstick findings, the appropriate steps for investigation, and when specialist referral is warranted. The conversation emphasises the importance of not overlooking persistent haematuria, while also acknowledging the challenges in balancing appropriate concern with unnecessary anxiety or over-referral.

The clinicians explore differential diagnoses, such as glomerulonephritis, IgA nephropathy, and hereditary conditions like thin basement membrane disorder or Alport syndrome. They stress the role of imaging, the presence of proteinuria, and age-based referral pathways in forming a management plan. A key theme is the long-term follow-up of patients with isolated haematuria, even when kidney function is normal, to monitor for progression via regular kidney health checks in primary care. The discussion is informative and grounded in real-world experience, aiming to clarify an area that is often perceived as ambiguous in general practice.

Three Main Takeaways:

1. Persistent microscopic haematuria warrants investigation and should not be dismissed, particularly when confirmed on repeat testing and associated with other findings such as proteinuria.
2. All patients with confirmed haematuria should undergo a renal ultrasound, and referral decisions should be guided by age and associated symptoms or findings. Generally, referrals are made to urology if the patient is over 50, and to nephrology if the patient is under 50 or if proteinuria is present.
3. Even when no serious underlying condition is identified, patients with isolated haematuria require annual monitoring, including blood pressure, kidney function (GFR), and urine albumin-to-creatinine ratio, ideally recorded in primary care records to ensure lifelong follow-up.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

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