Hematuria risk workflow

Workflow for hematuria visits emphasizing bleeding severity, obstruction/infection risk, and rapid urology handoff.

Medium-risk workflowLast reviewed September 4, 2026

AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.

Scope

Use for

Adult outpatient hematuria assessment; pregnancy and pediatric hematuria require separate pathways.

Not for

Hemodynamic instability, clot retention emergency, or severe sepsis presentations.
Inpatient procedural and surgical urology management.

Determine visible versus microscopic blood, symptoms, menstrual contamination, recent instrumentation, trauma and infection context; document smoking and malignancy risk factors.
Confirm a positive dipstick with urine microscopy. At least 3 RBC/hpf warrants risk assessment and an explicit investigation or follow-up plan; dipstick alone does not establish microscopic hematuria.

Treat these as urgent. Escalate early if concern persists or follow-up is unreliable.

Emergency assessment for clot retention, inability to void, heavy bleeding with instability, or fever with suspected obstructed urinary tract.
Acute kidney injury, severe pain or systemic illness requires urgent assessment.

Check blood pressure, creatinine/eGFR and urine albumin-to-creatinine ratio; culture urine when infection is suspected. Consider nephrology as well as urology for proteinuria or renal dysfunction.
Treat a confirmed transient cause and arrange repeat urine testing after resolution. Anticoagulant use does not remove the need to evaluate hematuria.
Unexplained visible hematuria warrants prompt urology referral even after a single episode; do not wait for recurrence or completion of imaging to refer.
Use the regional risk-based pathway for microscopic hematuria, imaging and cystoscopy. Kidney/bladder ultrasound is often the initial microscopic-hematuria study; visible hematuria may require CT urography after assessing renal function and contraindications.

Track urine results, imaging and referral completion; do not leave persistent unexplained hematuria without a plan.
Re-evaluate new visible bleeding, urinary symptoms, increasing proteinuria or renal decline, including after a previously negative workup.

Return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

Point to the red flags above that apply to this patient.
Confirm follow-up timing and where to go after hours.
Attach a relevant handout to reinforce the plan.
Document disposition, rationale, unresolved uncertainty, and that precautions were understood.

Clinical owner: Family Medicine Editorial Team
Risk tier: Medium
Review cadence: Every 6 months
Last reviewed: September 4, 2026AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.
Review status: Evidence current. Next review due March 4, 2027.