Pathways and Stages Kidney disease pathway hematuria pathway diabetes pathway non-diabetic MRP CKD stages referral sheet
    Disclaimer: The information and data in this document ("Information") is based on scientific evidence current as of the date issued and is subject to change without notice. The Information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Any person consulting or applying the Information is expected to use independent medical judgment and expertise in the context of individual clinical circumstances. Winnipeg Regional Health Authority and the Manitoba Renal Program make no representation or guarantees of any kind whatsoever regarding the content or use or application of the Information and specifically disclaim any responsibility for its application or use in any way.

Hematuria Referral Pathway

To be used concomitantly with Kidney Disease Referral Pathway

N.B. See Proteinuria Conversion Table

Macroscopic Hematuria
OR
Microscopic Hematuria (>2 rbc’s on 2 out of 3 specimens)

  • ⇒ Next
Exclude transient causes such as UTI (Confirm any UTI with urine culture)

  • ⇒ Next
eGFR ≥ 60 AND ACR or PCR < 30

  • ⇒ YES
  • ⇒ NO
Refer to Urology

Repeat eGFR from serum creatinine, urea, electrolytes – Na, K, CI, HCO3, ACR or PCR at least once within 2 weeks. Order serum ANA, C3, C4.

  • ⇒ Next
eGFR declines by 20% in 1-30 days OR ACR or PCR > 300mg/mmol OR ANA > 1:80 OR complements decreased

  • ⇒ YES
  • ⇒ NO
Return to Kidney Disease Referral Pathway AND follow OR refer to Nephrology according to specified criteria.

If after patient has been accessed by Nephrology, cause of Hematuria has not been identified, refer to Urology.

Refer to Nephrology, URGENT. Repeat eGFR and serum electrolytes at least every 1-4 weeks until seen by nephrology

If after patient has been accessed by Nephrology, cause of Hematuria has not been identified, refer to Urology.

Cause of hematuria not identified

  • ⇒ Next