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Persistent isolated non-visible haematuria — MSRA MCQ

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ModerateMicrohematuriaPersistent isolated non-visible haematuriaMSRA

A 58-year-old woman has persistent non-visible haematuria identified during an insurance medical. She has no dysuria, urinary frequency, loin pain, fever, weight loss, visible haematuria, recent instrumentation or vigorous exercise. Samples were collected outside menstruation. She has never smoked. Urine microscopy confirms red cells on two properly collected early-morning specimens 3 months apart. Midstream urine cultures show no significant growth. Urine ACR is 1.9 mg/mmol, eGFR is stable at 92 mL/min/1.73 m², and blood pressure is 124/74 mmHg. Full blood count is normal. What is the most appropriate next management plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Monitor annually with repeat testing for haematuria, albuminuria, eGFR and blood pressure while haematuria persists

This patient has persistent invisible haematuria but no proteinuria, impaired kidney function, hypertension, urinary symptoms or other features suggesting renal or urological pathology requiring immediate referral. NICE recommends annual follow-up with repeat assessment of haematuria, proteinuria or albuminuria, GFR and blood pressure for persistent invisible haematuria without proteinuria. A suspected cancer pathway referral for bladder cancer is indicated for unexplained non-visible haematuria in people aged 60 years or over who also have dysuria or a raised white cell count. She is 58 years old and has neither feature. Non-urgent urology referral is not the NICE-directed next step for isolated persistent non-visible haematuria in this low-risk presentation. Nephrology referral would be appropriate if haematuria coexisted with ACR greater than 30 mg/mmol, or if other CKD referral criteria were met; her ACR and renal function are normal. Repeating culture and treating empirically would be inappropriate because she is asymptomatic and has already had negative cultures.

Reference: NICE NG203: Chronic kidney disease: assessment and management (2021) — https://www.nice.org.uk/guidance/ng203/chapter/Recommendations NICE NG203: Chronic kidney disease: assessment and management (2021) — https://www.nice.org.uk/guidance/ng203/chapter/Recommendations NICE NG12: Suspected cancer: recognition and referral — bladder cancer (Last updated 15 April 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer