Non-visible haematuria — MSRA MCQ

Correct answer: B — Measure eGFR and urine ACR, and obtain 2 further properly collected urine reagent-strip tests to assess persistence

Explanation lettering: C = shown as B · B = shown as C

This patient has incidental dipstick-positive non-visible haematuria without infective or urological red-flag symptoms. NICE recommends further evaluation of reagent-strip results of 1+ blood or greater, and specifically advises against using urine microscopy to confirm a positive dipstick result. Incidental haematuria should prompt CKD testing with eGFR and urine ACR. Persistence is established when 2 of 3 reagent-strip tests are positive; therefore, two additional properly collected samples are needed before deciding whether this is persistent invisible haematuria. If persistent haematuria is confirmed without albuminuria, renal impairment or an age-appropriate indication for malignancy investigation, annual monitoring of haematuria, albuminuria/proteinuria, eGFR and blood pressure is appropriate. A is wrong because microscopy is not recommended to confirm dipstick haematuria, and annual surveillance is premature. B is not indicated from one isolated positive strip in this asymptomatic 51-year-old. D omits the required renal assessment and does not establish persistence. E is incorrect because suspected bladder-cancer referral for unexplained non-visible haematuria requires age 60 years or over plus dysuria or a raised white cell count.

Reference: Chronic kidney disease: assessment and management (NG203), haematuria recommendations (2021) — https://www.nice.org.uk/guidance/ng203/chapter/Recommendations Chronic kidney disease: assessment and management (NG203), managing isolated invisible haematuria (2021) — https://www.nice.org.uk/guidance/ng203/chapter/Recommendations Chronic kidney disease: assessment and management (NG203), CKD testing and follow-up (2021) — https://www.nice.org.uk/guidance/ng203/chapter/Recommendations