Hematuria:

• Hematuria may signal underlying disease of the renal parenchyma or genitourinary tract. Inflammation or infection of the bladder or prostate is the most common cause; kidney stones, malignancy, and glomerular disease account for most of the remaining cases. The patient’s history, medication profile, and pattern of hematuria all yield diagnostic clues.
  
  
• Include a review of the patient’s medication profile in the initial examination. Hematuria can sometimes be caused by antibiotics, NSAIDs, chemotherapeutic agents, or anticoagulants.
  
  
• If a glomerular disease is suspected, measuring serum complement levels may help establish the diagnosis. Lower levels are associated with such conditions as systemic lupus erythematosus and postinfectious glomerulonephritis.
  
  
• Hematuria may occur in a patient being treated with anticoagulants, but this situation requires further evaluation.
  
  
• Isolated asymptomatic hematuria warrants a genitourinary tract evaluation, especially in older patients. The evaluation may include renal x-rays, cystoscopy, urine cytology, and other tests.
  
  
• In younger patients, periodic reevaluation of microscopic hematuria with urinalysis is probably sufficient.