A 59-year-old man has incidental non-visible haematuria identified during a hypertension review. He has no visible haematuria, dysuria, urinary

Question

A 59-year-old man has incidental non-visible haematuria identified during a hypertension review. He has no visible haematuria, dysuria, urinary frequency, loin pain, fever, weight loss, urinary tract infection symptoms, recent instrumentation or vigorous exercise. He stopped smoking 8 years ago (28 pack-years). Three correctly collected early-morning urine samples over 10 weeks show blood 2+, blood negative and blood 1+ on reagent strip. All midstream urine cultures show no significant growth. Urine ACR is 38 mg/mmol and 42 mg/mmol on repeat early-morning testing 12 weeks apart. His eGFR is stable at 86 mL/min/1.73 m² and blood pressure is 128/74 mmHg on ramipril 10 mg daily. Full blood count shows neutrophilia, with white cell counts of 12.4 × 10⁹/L and 12.7 × 10⁹/L 3 weeks apart. He is otherwise well and there is no clinical focus of infection. What is the most appropriate next management plan?

Accepted Answer

Refer for specialist nephrology assessment and arrange review of the persistent neutrophilia with appropriate safety-netting

Answer

Repeat urine microscopy to confirm haematuria before arranging renal or urological referral

Answer

Refer using a suspected cancer pathway for bladder cancer and arrange review of the persistent neutrophilia with appropriate safety-netting

Answer

Repeat urine reagent-strip testing, ACR, eGFR and blood pressure annually and arrange review of the persistent neutrophilia with appropriate safety-netting

Answer

Request urgent renal and bladder ultrasonography and arrange review of the persistent neutrophilia with appropriate safety-netting

Persistent invisible haematuria with A3 albuminuria — MSRA MCQ