Hematuria referral checklist

Urgency tier

• Emergency assessment for gross hematuria with clot retention, inability to void or hemodynamic compromise; prompt urology evaluation for unexplained visible blood even without these emergency features.
• Urgent same-day assessment for flank pain with fever or suspected obstruction.
• Rapidly rising creatinine or significant proteinuria.
• Unintentional weight loss or systemic symptoms.
• High-risk features (older age, smoking history).

Minimum pre-referral workup

• Confirm dipstick blood with urine microscopy; record the RBC/hpf result. Repeat after a transient cause resolves when appropriate, without delaying evaluation of unexplained visible hematuria.
• Urine culture if infection suspected.
• Serum creatinine and eGFR.
• Blood pressure and proteinuria assessment.
• Select imaging through the regional pathway: ultrasound is often used for microscopic hematuria; unexplained visible hematuria may require CT urography. Refer to urology concurrently rather than awaiting imaging completion.

Referral packet checklist

• Gross versus microscopic hematuria and duration.
• Associated symptoms (pain, dysuria) and infection history.
• Risk factors (smoking, occupational exposure).
• Lab results and imaging reports.
• Relevant medications (anticoagulants) and comorbidities.

Pre-referral optimization tasks

• Treat confirmed infection and repeat urinalysis post-treatment when appropriate.
• Review anticoagulant and antiplatelet plan if bleeding risk increases.
• Reinforce return precautions for clot retention, fever, severe pain, or urinary obstruction.

References

• BC Guidelines Workup of microscopic hematuria (opens in a new tab)
• Alberta Health Services Hematuria evaluation pathway (December 2024) (opens in a new tab)

Something out of date or unclear? Suggest an update. Leave out any patient details.