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Persistent glomerular haematuria — ESENeph MCQ

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HardChronic Kidney DiseasePersistent glomerular haematuriaESENeph

A 39-year-old woman is referred after an insurance medical. eGFR is 64 mL/min/1.73 m², urine ACR is 3 mg/mmol and dipstick shows blood 2+ on three occasions. Microscopy confirms dysmorphic red cells; blood pressure is 118/70 mmHg and renal ultrasound is normal. What is the most appropriate investigation?

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Correct answer: D — Urine microscopy and nephrology assessment for glomerular haematuria

Persistent haematuria with dysmorphic red cells suggests a glomerular source and warrants nephrology assessment, particularly if persistent or associated with other markers. Cystoscopy is more relevant to non-glomerular haematuria risk, especially older patients and smokers. Immediate biopsy is not automatically required without proteinuria, hypertension or declining eGFR. The pearl is that eGFR above 60 does not exclude kidney disease when urinary abnormalities persist.

Reference: NICE NG203; Renal Medicine 2022 Curriculum