Approach to Hematuria: Core Curriculum 2026

Hematuria is a frequent clinical finding in primary care, nephrology, and urology clinics. Accurate diagnosis after a positive dipstick requires confirmation with urine microscopy, with the American Urological Association (AUA) guidelines defining significant microscopic hematuria as ≥3 red blood cells per high-power field. Hematuria warrants careful evaluation to distinguish between glomerular and nonglomerular etiologies, with attention to risk factors for malignancy to ensure timely diagnosis. Recent updates to the AUA guidelines emphasize risk stratification, advocating tailored diagnostic approaches to optimize detection of urologic cancers while limiting unnecessary procedures, health care costs, and patient harm. This review covers the evaluation and management of hematuria, including risk profiling for malignancy. Evidence-based recommendations are provided for common clinical scenarios such as patients with hematuria from malignancy, kidney stones, and glomerular disease. This core curriculum guides clinicians through the nuanced decision making required in the diagnosis and management of hematuria, with reference to the latest guidelines.