Parenchymal imaging adds diagnostic utility in evaluating haematuria

To compare the findings of renal ultrasonography (US) in the evaluation of patients with and with no haematuria. The increased use of cross-sectional imaging and US has led to a dramatic improvement in the diagnosis of renal masses, such that computed tomography and/or US have been integrated into the diagnostic evaluation of haematuria, and many more incidental renal lesions are now detected. Thus it is possible that the lesions identified during evaluation for haematuria are incidental, i.e. identified serendipitously, and unrelated to the haematuria.

We retrospectively compared the US findings obtained from 301 patients referred for new-onset haematuria to those obtained from 600 patients being evaluated for other than urological reasons. All imaging and patient charts were reviewed to verify the clinical and radiological data.

Haematuria was associated with all renal abnormalities, with an odds ratio (OR, 95% confidence interval) of 4.7 (3.6-7.3). Importantly, haematuria was associated with a renal mass, with an OR of 6.7 (2.8-16.3). Subset analysis revealed that patients with macroscopic and microscopic haematuria had significantly more renal abnormalities (OR 4.7, 2.7-8.2, and 5.3, 3.2-8.8, respectively) and renal masses (OR 7.3, 2.7-20.3, and 6.5, 2.3-18.6, respectively) than controls.

Both macroscopic and microscopic haematuria are associated with a greater risk of identifying renal lesions. This supports the conclusion that the renal lesions identified with modern imaging techniques during the evaluation of both microscopic and macroscopic haematuria are not serendipitous.