Hematuria initial risk assessment
Primary care hematuria framework emphasizing malignant, obstructive, and infectious red-flag exclusion.
Last reviewed February 7, 2026
Red flags
- Gross hematuria with clots causing retention or hemodynamic compromise.
- Hematuria with severe flank pain, fever, or acute kidney injury concern.
- Persistent unexplained hematuria in high-risk populations.
Assessment priorities
- Confirm gross versus microscopic hematuria and associated symptoms.
- Review anticoagulation status, trauma, infection signs, and renal risk factors.
- Assess for flank pain, clot retention, or systemic instability.
Initial management
- Stabilize and stratify urgency based on bleeding severity and associated findings.
- Start targeted workup and document risk factors clearly.
- Define immediate versus expedited referral threshold.
Follow-up and escalation
- Ensure timely reassessment and trend review.
- Escalate for worsening bleeding, obstruction, infection, or renal decline.
- Coordinate urology pathway for persistent unexplained cases.
References
- Canadian Urological Association guidelines (opens in a new tab)
- Choosing Wisely Canada recommendations (opens in a new tab)
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