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Should the upper tracts be imaged for microscopic haematuria?
Murray S Feldstein1, Joseph G Hentz, Michael D Gillett
1Department of Urology, Mayo Clinic, Scottsdale, Arizona 85259, USA. Feldstein.Murray@mayo.edu
BJU International
|August 18, 2005
Summary
Microscopic haematuria (MH) definitions of 4 or 5 red blood cells per high-power field (RBC/HPF) are more prevalent in renal neoplasm patients. However, these findings have limited impact on detecting renal cancer, suggesting careful consideration before imaging.
Area of Science:
- Urology
- Nephrology
- Oncology
Background:
- Microscopic haematuria (MH) is a potential indicator for renal neoplasms.
- Various definitions of MH exist, impacting diagnostic utility.
Purpose of the Study:
- To compare the prevalence of different microscopic haematuria definitions in patients with and without renal neoplasms.
- To assess the predictive value of these MH definitions for renal imaging outcomes.
Main Methods:
- Retrospective case-control study of 278 patients with renal neoplasms and matched controls.
- Analysis of 13 definitions of MH using conditional logistic regression.
- Calculation of odds ratios (OR) and hypothetical performance characteristics.
Main Results:
- MH defined as ≥4 or ≥5 red blood cells per high-power field (RBC/HPF) showed increased prevalence (OR 2.0-2.2) in renal neoplasm patients.
- No significant association was found for definitions of ≤3 RBC/HPF.
- Symptomatic patients with MH (≥5 RBC/HPF) had a higher OR (13.68), but sensitivity decreased with stricter definitions.
Conclusions:
- Patients with renal neoplasms show a doubled prevalence of MH (≥4 or ≥5 RBC/HPF) compared to controls.
- The diagnostic yield of imaging based on low-grade MH in asymptomatic individuals is limited.
- Clinical context and degree of MH are crucial for deciding on kidney imaging.