At 03:25 24/08/2007, you wrote:
>Thoughts please on the next step if any.=20
>52 year old male, previously well found to have microscopic haematuria on=
>=20
>Insurance Medial.
>Urinary tract ultrasound NAD, IVU NAD.
>Microscopic haematuria persists.
>Would you send him to a urologist or assume it was benign renal haematuri=
>a=20
>(? thin membrane disease)
>The patient is not keen on referral at this time
Firstly should confirm this (email and thread) is discussion between
doctors, and NOT direct or indirect patient advice.
Standard UK procedure would probably be to:
Check BP, renal chemistry these days including eGFR, urine cytology
Confirm that the haematuria is genuine on MSU x 2, NOT just on dipstix
Quantify - VERY low level microscopic haematuria (<5 RBC / mm3) might
simply be ignored or merit FU only
Depending on your point of view ask the patient if they have any
local lesion or examine the patient in detail for any local lesion -
our urologists are particularly fussed about this after 1 patient in
20 yrs was referred for cystoscopy but had a penile tumour (not a
patient I or my practice had any contact with, but I felt quite
supportive of the GP concerned).
I recollect reading some years ago that some kind of stereo
microscopy could be used to differentiate renal and LUT blood loss,
but I've asked about this a few times since and no-one locally has
taken it up or thought it worth pursuing, and never got high enough
on my priority list to find out more.
It is in the end the patient's decision. The chance of finding a
bladder tumour with _microscopic_ haematuria, normal US and IVU is
probably not all that high. The chances of treatment now rather than
in 6m altering the outcome .... not sure. Still, the patient
presumably can't get insurance, comprehensive travel insurance etc
until this is resolved, so I guess most people would go for the test.
As ever interested to hear the views of others.
Best wishes,
Julian
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